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General NPI Number Information
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NPI Number | 1447590344
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Entity Type | Individual
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Provider Name | LYNANN MARIE MASTAJ DMD
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Gender | Female
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Dates
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Enumeration Date | 03/01/2013
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 976 E RAILROAD AVE SUITE 100
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City | BRYN MAWR
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State | PA
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Zip | 19010-3855
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Country | US
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Telephone | 610-525-2277
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Fax | 484-380-2763
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Provider Business Mailing Address
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Address Line | 976 E RAILROAD AVE SUITE 100
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City | BRYN MAWR
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State | PA
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Zip | 19010-3855
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Country | US
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Telephone | 610-525-2277
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Fax | 484-380-2763
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 26368
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License Number State | PA
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