Provider Demographics
NPI:1760533889
Name:WAN, LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:WAN
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 1:3687 LAS POSAS RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1482
Mailing Address - Country:US
Mailing Address - Phone:805-484-2705
Mailing Address - Fax:805-484-5908
Practice Address - Street 1:3687 LAS POSAS RD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1482
Practice Address - Country:US
Practice Address - Phone:805-484-2705
Practice Address - Fax:805-484-5908
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry