Healthcare Provider Details

I. General information

NPI: 1700744034
Provider Name (Legal Business Name): LYNN FAMILY DENTAL AND ORTHODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 COPELAND ST STE 330
QUINCY MA
02169-4082
US

IV. Provider business mailing address

234 COPELAND ST STE 330
QUINCY MA
02169-4082
US

V. Phone/Fax

Practice location:
  • Phone: 617-401-8298
  • Fax: 617-997-0030
Mailing address:
  • Phone: 617-401-8298
  • Fax: 617-997-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NEETU BANSAL
Title or Position: OWNER
Credential: DMD
Phone: 617-401-8298