Provider Demographics
NPI:1902053309
Name:LYN, TREVANN F (DMD)
Entity Type:Individual
Prefix:DR
First Name:TREVANN
Middle Name:F
Last Name:LYN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7544 BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4108
Mailing Address - Country:US
Mailing Address - Phone:410-665-2500
Mailing Address - Fax:304-274-9546
Practice Address - Street 1:7544 BELAIR RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4108
Practice Address - Country:US
Practice Address - Phone:410-665-2500
Practice Address - Fax:410-665-3235
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39851223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810023314Medicaid