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General NPI Number Information
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NPI Number | 1013697390
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Entity Type | Organization
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Legal Business Name | LYNN DAZ, D.D.S. ,INC.
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Dates
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Enumeration Date | 07/20/2023
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 24099 POSTAL AVE STE 101
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City | MORENO VALLEY
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State | CA
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Zip | 92553-7709
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Country | US
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Telephone | 951-601-1290
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Fax | 951-601-1292
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Provider Business Mailing Address
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Address Line | 24099 POSTAL AVE STE 101
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City | MORENO VALLEY
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State | CA
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Zip | 92553-7709
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Country | US
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Telephone | 951-601-1290
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LYNN DIAZ
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Credential |
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Telephone | 951-601-1290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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