Provider Demographics
NPI:1659523439
Name:BETHEL, LYNN ANN (RDH, BSDH, MPH)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ANN
Last Name:BETHEL
Suffix:
Gender:F
Credentials:RDH, BSDH, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 WASHINGTON ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-4603
Mailing Address - Country:US
Mailing Address - Phone:617-624-6074
Mailing Address - Fax:617-624-6062
Practice Address - Street 1:250 WASHINGTON ST FL 5
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-4603
Practice Address - Country:US
Practice Address - Phone:617-624-6074
Practice Address - Fax:617-624-6062
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7430124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist