Provider Demographics
NPI:1518246867
Name:SEEWALD, LYNN A
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:A
Last Name:SEEWALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:A
Other - Last Name:BACHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:21 JEFFERSON CT
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-2201
Mailing Address - Country:US
Mailing Address - Phone:585-613-6889
Mailing Address - Fax:
Practice Address - Street 1:325 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-2118
Practice Address - Country:US
Practice Address - Phone:585-919-0267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025508-1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist