Provider Demographics
NPI:1932388550
Name:YOUNG, LYNNETTE ROCHELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LYNNETTE
Middle Name:ROCHELLE
Last Name:YOUNG
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 1:2005 LYNNHAVEN PKWY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-1410
Mailing Address - Country:US
Mailing Address - Phone:757-554-0962
Mailing Address - Fax:757-554-0964
Practice Address - Street 1:2005 LYNNHAVEN PKWY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-1410
Practice Address - Country:US
Practice Address - Phone:757-554-0962
Practice Address - Fax:757-554-0964
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA70361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice