Provider Demographics
NPI:1568953867
Name:SMILELYNN PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:SMILELYNN PEDIATRIC DENTISTRY
Other - Org Name:LYNN PEDIATRIC DENTISTRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:812-298-3719
Mailing Address - Street 1:2812 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-4784
Mailing Address - Country:US
Mailing Address - Phone:813-298-3719
Mailing Address - Fax:
Practice Address - Street 1:122 HARBOR VILLAGE LN
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-3402
Practice Address - Country:US
Practice Address - Phone:813-298-3719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN213391223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty