MEDICARE: DR. LYNN THORNTON JETT D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	0401006321	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	091586	OTHER	VA	ANTHEM PROVIDER NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588779086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNN THORNTON JETT D.D.S.

Provider Business Mailing Address
First Line	:	3116 TYRE NECK RD.
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23703
Country	:	US
Telephone Number	:	757-483-2110
Fax Number	:	757-686-0679

Provider Business Practice Location Address
First Line	:	3116 TYRE NECK RD
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23703
Country	:	US
Telephone Number	:	757-483-2110
Fax Number	:	757-686-0679

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	01/25/2026

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