Provider Demographics
NPI:1144431065
Name:LYNANN MASTAJ D.M.D.
Entity type:Organization
Organization Name:LYNANN MASTAJ D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LYNANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-525-1200
Mailing Address - Street 1:976 E RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3831
Mailing Address - Country:US
Mailing Address - Phone:610-525-1200
Mailing Address - Fax:
Practice Address - Street 1:976 E RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3831
Practice Address - Country:US
Practice Address - Phone:610-525-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026368L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty