Provider Demographics
NPI:1639198310
Name:LYNN, DAVID BROCK JR (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BROCK
Last Name:LYNN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:BROCK
Other - Last Name:LYNN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS, PA
Mailing Address - Street 1:6190 LYNDON B JOHNSON FWY
Mailing Address - Street 2:SUITE 900
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6344
Mailing Address - Country:US
Mailing Address - Phone:972-934-1400
Mailing Address - Fax:972-934-0195
Practice Address - Street 1:6190 LYNDON B JOHNSON FWY
Practice Address - Street 2:SUITE 900
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6344
Practice Address - Country:US
Practice Address - Phone:972-934-1400
Practice Address - Fax:972-934-0195
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125901223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics