Provider Demographics
NPI:1437885019
Name:LYN, SHEENA (DMD)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:
Last Name:LYN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3668 W ANTHEM WAY STE 162
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-0468
Mailing Address - Country:US
Mailing Address - Phone:623-323-7885
Mailing Address - Fax:
Practice Address - Street 1:3668 W ANTHEM WAY STE 162
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0468
Practice Address - Country:US
Practice Address - Phone:623-323-7885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0115291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice