Provider Demographics
NPI:1134415813
Name:PAUL, LINCY MARY (DDS)
Entity type:Individual
Prefix:DR
First Name:LINCY
Middle Name:MARY
Last Name:PAUL
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 1:919 BRIAR GLEN LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-8574
Mailing Address - Country:US
Mailing Address - Phone:651-269-1080
Mailing Address - Fax:651-269-1080
Practice Address - Street 1:1680 SUBURBAN AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-6632
Practice Address - Country:US
Practice Address - Phone:651-209-3139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND129471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice