Provider Demographics
NPI:1699398404
Name:LYNASS, SAMUEL ROBB (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ROBB
Last Name:LYNASS
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:MCRD PARRIS ISLAND
Mailing Address - Street 2:674 BLVD DE FRANCE
Mailing Address - City:FPO
Mailing Address - State:AA
Mailing Address - Zip Code:29906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MCRD PARRIS ISLAND
Practice Address - Street 2:674 BLVD DE FRANCE
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:29906
Practice Address - Country:US
Practice Address - Phone:843-228-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000204395122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist