Healthcare Provider Details

I. General information

NPI: 1255428801
Provider Name (Legal Business Name): LYNN ARLEN PESTLE DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 ELMWOOD AVENUE
LAFAYETTE IN
47904
US

IV. Provider business mailing address

2550 ELMWOOD AVENUE
LAFAYETTE IN
47904
US

V. Phone/Fax

Practice location:
  • Phone: 765-447-7887
  • Fax: 765-447-7349
Mailing address:
  • Phone: 765-447-7887
  • Fax: 765-447-7349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12007506A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number12007506A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: