Provider Demographics
NPI:1497208730
Name:RALPH, LINZI (DMD)
Entity Type:Individual
Prefix:
First Name:LINZI
Middle Name:
Last Name:RALPH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LINZI
Other - Middle Name:
Other - Last Name:PRYOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BLDG 6837 NORMANDY ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-396-6602
Mailing Address - Fax:
Practice Address - Street 1:BLDG 6837 NORMANDY ROAD
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-396-6602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8610124Q00000X
KY10928122300000X, 1223G0001X
FL28823122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No124Q00000XDental ProvidersDental Hygienist
No1223G0001XDental ProvidersDentistGeneral Practice