Provider Demographics
NPI:1639456668
Name:LYNETTE S. CROCKER, DDS, PA
Entity Type:Organization
Organization Name:LYNETTE S. CROCKER, DDS, PA
Other - Org Name:DURHAM DENTAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:STEVENS
Authorized Official - Last Name:CROCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-544-6727
Mailing Address - Street 1:6104 FAYETTEVILLE ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6283
Mailing Address - Country:US
Mailing Address - Phone:919-544-6727
Mailing Address - Fax:919-484-1434
Practice Address - Street 1:6104 FAYETTEVILLE ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6283
Practice Address - Country:US
Practice Address - Phone:919-544-6727
Practice Address - Fax:919-484-1434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty