Provider Demographics
NPI:1063703080
Name:ALBANDOZ- FUENTES, LYNDA M (DMD)
Entity type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:M
Last Name:ALBANDOZ- FUENTES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10017 NORTHERN BLVD
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1038
Mailing Address - Country:US
Mailing Address - Phone:718-424-9210
Mailing Address - Fax:718-424-9200
Practice Address - Street 1:10017 NORTHERN BLVD
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1038
Practice Address - Country:US
Practice Address - Phone:718-424-9210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055258-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist