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NPI 1467507236

NPI 1467507236 : SUZANNE TEEL LYNN DMD : MOODY, AL

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General NPI Number Information
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    NPI Number           |    1467507236
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    Entity Type          |    Individual 
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    Provider Name        |    SUZANNE TEEL LYNN DMD
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    01/24/2007
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    2323 MOODY PKWY 
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    City                 |    MOODY
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    State                |    AL
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    Zip                  |    35004-3012
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    Country              |    US
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    Telephone            |    205-640-1717
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    3906 GLENWOOD AVE 
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    City                 |    BIRMINGHAM
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    State                |    AL
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    Zip                  |    35222-4204
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    Country              |    US
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    Telephone            |    205-936-0492
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    Fax                  |    
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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        |    122300000X
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    Taxonomy Name        |    Dentist
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    License Number       |    5365
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    License Number State |    AL
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