Healthcare Provider Details

I. General information

NPI: 1134046865
Provider Name (Legal Business Name): LYNN LILLY VARGHESE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CLUBHOUSE BAY
HENDERSONVILLE TN
37075-2896
US

IV. Provider business mailing address

109 CLUBHOUSE BAY
HENDERSONVILLE TN
37075-2896
US

V. Phone/Fax

Practice location:
  • Phone: 857-265-8032
  • Fax:
Mailing address:
  • Phone: 857-265-8032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13238
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: