Provider Demographics
NPI:1871509539
Name:CHILBERG, LYNNE MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:MARIE
Last Name:CHILBERG
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 1:4163 HAINES RD
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-3942
Mailing Address - Country:US
Mailing Address - Phone:218-722-2428
Mailing Address - Fax:218-722-2428
Practice Address - Street 1:4163 HAINES RD
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-3942
Practice Address - Country:US
Practice Address - Phone:218-722-2428
Practice Address - Fax:218-722-2428
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist