Provider Demographics
NPI:1255428801
Name:PESTLE, LYNN ARLEN (DDS MS)
Entity type:Individual
Prefix:MR
First Name:LYNN
Middle Name:ARLEN
Last Name:PESTLE
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2550 ELMWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904
Mailing Address - Country:US
Mailing Address - Phone:765-447-7887
Mailing Address - Fax:765-447-7349
Practice Address - Street 1:2550 ELMWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904
Practice Address - Country:US
Practice Address - Phone:765-447-7887
Practice Address - Fax:765-447-7349
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007506A1223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0700XDental ProvidersDentistProsthodontics