Provider Demographics
NPI:1699737833
Name:LYNNE, RICHARD E (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:LYNNE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4431 68TH ST
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:254-287-2705
Mailing Address - Fax:254-287-1786
Practice Address - Street 1:4431 68TH ST
Practice Address - Street 2:US ARMY DENTAL ACTIVITY
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-287-2705
Practice Address - Fax:254-287-1786
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE74211223E0200X
WI41321223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics