Provider Demographics
NPI:1992006449
Name:LYNNE C. FAXIO, DDS, P.C.
Entity type:Organization
Organization Name:LYNNE C. FAXIO, DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:FAXIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-934-6040
Mailing Address - Street 1:2999 CORPORATE LN
Mailing Address - Street 2:SUITE B11
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8478
Mailing Address - Country:US
Mailing Address - Phone:757-934-6040
Mailing Address - Fax:757-934-6042
Practice Address - Street 1:2999 CORPORATE LN
Practice Address - Street 2:SUITE B11
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8478
Practice Address - Country:US
Practice Address - Phone:757-934-6040
Practice Address - Fax:757-934-6042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-14
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty