Provider Demographics
NPI:1952573297
Name:JOHN W LYNN DDS LTD
Entity Type:Organization
Organization Name:JOHN W LYNN DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WORTH
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-432-0056
Mailing Address - Street 1:104 MORTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805
Mailing Address - Country:US
Mailing Address - Phone:804-732-0056
Mailing Address - Fax:804-732-1420
Practice Address - Street 1:104 MORTON AVENUE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805
Practice Address - Country:US
Practice Address - Phone:804-732-0056
Practice Address - Fax:804-732-1420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010028961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty