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General NPI Number Information
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NPI Number | 1144431065
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Entity Type | Organization
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Legal Business Name | LYNANN MASTAJ D.M.D.
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 976 E RAILROAD AVE
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City | BRYN MAWR
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State | PA
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Zip | 19010-3831
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Country | US
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Telephone | 610-525-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 976 E RAILROAD AVE
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City | BRYN MAWR
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State | PA
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Zip | 19010-3831
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Country | US
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Telephone | 610-525-1200
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | LYNANN MASTAJ
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Credential | D.M.D.
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Telephone | 610-525-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DS026368L
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License Number State | PA
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