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General NPI Number Information
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NPI Number | 1952573297
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Entity Type | Organization
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Legal Business Name | JOHN W LYNN DDS LTD
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 104 MORTON AVENUE
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City | PETERSBURG
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State | VA
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Zip | 23805
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Country | US
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Telephone | 804-732-0056
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Fax | 804-732-1420
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Provider Business Mailing Address
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Address Line | 104 MORTON AVENUE
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City | PETERSBURG
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State | VA
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Zip | 23805
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Country | US
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Telephone | 804-732-0056
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Fax | 804-732-1420
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | JOHN WORTH LYNN
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Credential | DDS
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Telephone | 804-432-0056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401002896
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License Number State | VA
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