Provider Demographics
NPI:1366110918
Name:FURNISH, TREVOR LINCOLN (DDS)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:LINCOLN
Last Name:FURNISH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:IN
Mailing Address - Zip Code:46761-1740
Mailing Address - Country:US
Mailing Address - Phone:126-046-3365
Mailing Address - Fax:
Practice Address - Street 1:108 S TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-1740
Practice Address - Country:US
Practice Address - Phone:126-046-3365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013367A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice