Provider Demographics
NPI:1962425827
Name:MANDYBUR, LINA LENA (DDS)
Entity type:Individual
Prefix:DR
First Name:LINA
Middle Name:LENA
Last Name:MANDYBUR
Suffix:
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 1:8471 WETHERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2249
Mailing Address - Country:US
Mailing Address - Phone:513-521-0461
Mailing Address - Fax:513-487-6660
Practice Address - Street 1:8471 WETHERFIELD LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2249
Practice Address - Country:US
Practice Address - Phone:513-521-0461
Practice Address - Fax:513-487-6660
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40063122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist