Provider Demographics
NPI:1700884962
Name:CHENEY, LYNN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:R
Last Name:CHENEY
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 1:13525 NE 188TH PL
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8764
Mailing Address - Country:US
Mailing Address - Phone:206-353-7253
Mailing Address - Fax:
Practice Address - Street 1:13525 NE 188TH PL
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8764
Practice Address - Country:US
Practice Address - Phone:206-353-7253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2012-10-03
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
WADE000085241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE00008524OtherSTATE LICENSE