Provider Demographics
NPI:1982198255
Name:PHAN, LYNDA MINH (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:MINH
Last Name:PHAN
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 1:3922 14TH AVE S APT C
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1470
Mailing Address - Country:US
Mailing Address - Phone:360-878-5436
Mailing Address - Fax:
Practice Address - Street 1:509 OLIVE WAY STE 1538
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1749
Practice Address - Country:US
Practice Address - Phone:206-343-8774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60861704122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist