Provider Demographics
NPI:1639661952
Name:VEGA, LYNDA LEE (DDS)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:LEE
Last Name:VEGA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LIDYA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1400 BARTON RD APT 1302
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5448
Mailing Address - Country:US
Mailing Address - Phone:970-556-1619
Mailing Address - Fax:
Practice Address - Street 1:38761 CHERRY VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92223-4239
Practice Address - Country:US
Practice Address - Phone:951-769-5487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1033871223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice