Provider Demographics
NPI:1720154412
Name:NYBERG, LYNNETTE ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LYNNETTE
Middle Name:ANN
Last Name:NYBERG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 BICENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2140
Mailing Address - Country:US
Mailing Address - Phone:603-622-7500
Mailing Address - Fax:603-622-5648
Practice Address - Street 1:1100 BICENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2140
Practice Address - Country:US
Practice Address - Phone:603-622-7500
Practice Address - Fax:603-622-5648
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH25301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics