Provider Demographics
NPI:1851765556
Name:LYNN FAMILY DENTISTRY
Entity Type:Organization
Organization Name:LYNN FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACE
Authorized Official - Middle Name:LANIER
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-625-9911
Mailing Address - Street 1:3107 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-6201
Mailing Address - Country:US
Mailing Address - Phone:337-625-9911
Mailing Address - Fax:
Practice Address - Street 1:3107 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-6201
Practice Address - Country:US
Practice Address - Phone:337-625-9911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA59701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty