Provider Demographics
NPI:1477700532
Name:PAGE, P. LYNETTE (D D S)
Entity Type:Individual
Prefix:DR
First Name:P. LYNETTE
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 GREENVILLE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-1030
Mailing Address - Country:US
Mailing Address - Phone:214-692-7499
Mailing Address - Fax:214-361-4145
Practice Address - Street 1:6500 GREENVILLE AVE STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-1030
Practice Address - Country:US
Practice Address - Phone:214-692-7499
Practice Address - Fax:214-361-4145
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX241751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice