Provider Demographics
NPI:1154988517
Name:BOON, ANTHONY LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:LYNN
Last Name:BOON
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 1:734 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2609
Mailing Address - Country:US
Mailing Address - Phone:405-820-2204
Mailing Address - Fax:
Practice Address - Street 1:734 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2609
Practice Address - Country:US
Practice Address - Phone:405-820-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN125991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice