Provider Demographics
NPI:1194763854
Name:LINVILLE-LAURITANO, LYNN III (DDS)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:LINVILLE-LAURITANO
Suffix:III
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 1:2605 BLUE RIDGE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6475
Mailing Address - Country:US
Mailing Address - Phone:919-781-8920
Mailing Address - Fax:919-571-9543
Practice Address - Street 1:2605 BLUE RIDGE RD
Practice Address - Street 2:STE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6475
Practice Address - Country:US
Practice Address - Phone:919-781-8920
Practice Address - Fax:919-571-9543
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC50301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899-5309Medicaid