Provider Demographics
NPI:1962500298
Name:GASSOWAY, LYNN E (DDS)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:E
Last Name:GASSOWAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:LYNN
Other - Middle Name:E
Other - Last Name:REICHLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8412 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403
Mailing Address - Country:US
Mailing Address - Phone:219-938-2875
Mailing Address - Fax:216-938-2875
Practice Address - Street 1:8412 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403
Practice Address - Country:US
Practice Address - Phone:219-938-2875
Practice Address - Fax:216-938-2875
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120071491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice