Provider Demographics
NPI:1699784421
Name:BROCK, LYNNE A (DDS)
Entity type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:A
Last Name:BROCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20350 WATER TOWER BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-3558
Mailing Address - Country:US
Mailing Address - Phone:262-327-6100
Mailing Address - Fax:262-717-9642
Practice Address - Street 1:20350 WATER TOWER BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-3558
Practice Address - Country:US
Practice Address - Phone:262-327-6100
Practice Address - Fax:262-717-9642
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43911223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics