Provider Demographics
NPI:1730321555
Name:GILL, LYNN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:C
Last Name:GILL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 W BOSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-1774
Mailing Address - Country:US
Mailing Address - Phone:313-598-0984
Mailing Address - Fax:
Practice Address - Street 1:1716 W BOSTON BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1774
Practice Address - Country:US
Practice Address - Phone:313-598-0984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010173811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice