Provider Demographics
NPI:1063401545
Name:MARR, LYNN WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:WILLIAM
Last Name:MARR
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 1:2534 UNIVERSITY DR S
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5700
Mailing Address - Country:US
Mailing Address - Phone:701-293-0761
Mailing Address - Fax:701-293-6158
Practice Address - Street 1:2534 UNIVERSITY DR S
Practice Address - Street 2:SUITE 3
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5700
Practice Address - Country:US
Practice Address - Phone:701-293-0761
Practice Address - Fax:701-293-6158
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1481122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist