Provider Demographics
NPI:1194880856
Name:THOMAS, LYNN R (DDS)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:R
Last Name:THOMAS
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 1:1731 E BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-3968
Mailing Address - Country:US
Mailing Address - Phone:574-262-4211
Mailing Address - Fax:574-264-3736
Practice Address - Street 1:1731 E BRISTOL ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3968
Practice Address - Country:US
Practice Address - Phone:574-262-4211
Practice Address - Fax:574-264-3736
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120075311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice