Provider Demographics
NPI:1205923513
Name:SMITH, LYNN E (DMD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 SW MERCANTILE DR.
Mailing Address - Street 2:SUITE 167
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:503-675-7333
Mailing Address - Fax:503-675-7272
Practice Address - Street 1:3975 MERCANTILE DR
Practice Address - Street 2:SUITE 167
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3595
Practice Address - Country:US
Practice Address - Phone:503-675-7333
Practice Address - Fax:503-675-7272
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD60121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice