Provider Demographics
NPI:1720168875
Name:VAN PELT, LYNN C (DMD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:C
Last Name:VAN PELT
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 1:801 THOMPSON AVE
Mailing Address - Street 2:SUITE 338
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1627
Mailing Address - Country:US
Mailing Address - Phone:301-443-2017
Mailing Address - Fax:301-594-6610
Practice Address - Street 1:801 THOMPSON AVE
Practice Address - Street 2:SUITE 338
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1627
Practice Address - Country:US
Practice Address - Phone:301-443-2017
Practice Address - Fax:301-594-6610
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2982-971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice