Provider Demographics
NPI:1538440391
Name:ALEXANDER, LYNN KIANGSOONTRA (DDS1)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:KIANGSOONTRA
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:DDS1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 PARNASSUS AVE
Mailing Address - Street 2:DENTAL CLINICS BUILDING, D4000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2210
Mailing Address - Country:US
Mailing Address - Phone:415-476-3028
Mailing Address - Fax:
Practice Address - Street 1:4322 RAVENSWORTH RD
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-5630
Practice Address - Country:US
Practice Address - Phone:703-256-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP2661223P0700X
MNR5211223P0700X
VA04014149191223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics