Provider Demographics
NPI:1154708600
Name:DUNHAM, LYNNE ALICE (DDS)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:ALICE
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 NW 120TH CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-1700
Mailing Address - Country:US
Mailing Address - Phone:405-722-0841
Mailing Address - Fax:
Practice Address - Street 1:6001 NW 120TH CT
Practice Address - Street 2:SUITE 1
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-1700
Practice Address - Country:US
Practice Address - Phone:405-722-0841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK4226122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist