Provider Demographics
NPI:1831577675
Name:GREGORINI, LYNDA (RDH)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:GREGORINI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28037 W MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:ECKERMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49728-9700
Mailing Address - Country:US
Mailing Address - Phone:906-437-1055
Mailing Address - Fax:906-248-2909
Practice Address - Street 1:12124 W LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:BRIMLEY
Practice Address - State:MI
Practice Address - Zip Code:49715-9319
Practice Address - Country:US
Practice Address - Phone:906-248-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902012783124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist