Healthcare Provider Details

I. General information

NPI: 1639198310
Provider Name (Legal Business Name): DAVID BROCK LYNN JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAVID BROCK LYNN JR. D.D.S., M.S., P.A.

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6190 LYNDON B JOHNSON FWY SUITE 900
DALLAS TX
75240-6344
US

IV. Provider business mailing address

6190 LYNDON B JOHNSON FWY SUITE 900
DALLAS TX
75240-6344
US

V. Phone/Fax

Practice location:
  • Phone: 972-934-1400
  • Fax: 972-934-0195
Mailing address:
  • Phone: 972-934-1400
  • Fax: 972-934-0195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number12590
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: