Healthcare Provider Details

I. General information

NPI: 1902053309
Provider Name (Legal Business Name): TREVANN F LYN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7544 BELAIR RD
NOTTINGHAM MD
21236-4108
US

IV. Provider business mailing address

7544 BELAIR RD
NOTTINGHAM MD
21236-4108
US

V. Phone/Fax

Practice location:
  • Phone: 410-665-2500
  • Fax: 410-665-3235
Mailing address:
  • Phone: 410-665-2500
  • Fax: 304-274-9546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3985
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: