Provider Demographics
NPI:1023218823
Name:EDWARD A. LYNN, D.D.S., P.C.
Entity type:Organization
Organization Name:EDWARD A. LYNN, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-946-1823
Mailing Address - Street 1:466 E CALAVERAS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-5453
Mailing Address - Country:US
Mailing Address - Phone:408-946-1823
Mailing Address - Fax:408-956-1110
Practice Address - Street 1:466 E CALAVERAS BLVD STE A
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5453
Practice Address - Country:US
Practice Address - Phone:408-946-1823
Practice Address - Fax:408-956-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADB026887261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental