Provider Demographics
NPI:1902905532
Name:EDWARDS, LYNN MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:EDWARDS
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 1:324 N SAN MATEO DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2514
Mailing Address - Country:US
Mailing Address - Phone:650-342-9571
Mailing Address - Fax:650-342-9678
Practice Address - Street 1:324 N SAN MATEO DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2514
Practice Address - Country:US
Practice Address - Phone:650-342-9571
Practice Address - Fax:650-342-9678
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice