Healthcare Provider Details

I. General information

NPI: 1023142767
Provider Name (Legal Business Name): LYNN ZWAHLEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E ORANGEBURG AVE STE C
MODESTO CA
95350-5355
US

IV. Provider business mailing address

201 E ORANGEBURG AVE STE C
MODESTO CA
95350-5355
US

V. Phone/Fax

Practice location:
  • Phone: 209-522-5761
  • Fax: 209-522-1051
Mailing address:
  • Phone: 209-522-5761
  • Fax: 209-522-1051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number29862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: