Provider Demographics
NPI:1013697390
Name:LYNN DAZ, D.D.S. ,INC.
Entity Type:Organization
Organization Name:LYNN DAZ, D.D.S. ,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-601-1290
Mailing Address - Street 1:24099 POSTAL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-7709
Mailing Address - Country:US
Mailing Address - Phone:951-601-1290
Mailing Address - Fax:
Practice Address - Street 1:24099 POSTAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-7709
Practice Address - Country:US
Practice Address - Phone:951-601-1290
Practice Address - Fax:951-601-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty