Provider Demographics
NPI:1417017807
Name:SHOOK, LYNLEY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYNLEY
Middle Name:A
Last Name:SHOOK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 FM 2222, SUITE S
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730
Mailing Address - Country:US
Mailing Address - Phone:512-795-2800
Mailing Address - Fax:512-795-2814
Practice Address - Street 1:10601 FM 2222, SUITE S
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730
Practice Address - Country:US
Practice Address - Phone:512-795-2800
Practice Address - Fax:512-795-2814
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice