Provider Demographics
NPI:1821372301
Name:BODE, LYNN DELL (DDS)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:DELL
Last Name:BODE
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 1:2000 NATIONAL RD W
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-3854
Mailing Address - Country:US
Mailing Address - Phone:765-488-1072
Mailing Address - Fax:765-381-1031
Practice Address - Street 1:2000 NATIONAL RD W
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-3854
Practice Address - Country:US
Practice Address - Phone:765-488-1072
Practice Address - Fax:765-381-1031
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011792A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics