Individual provider Active NPI

Lynn Marie Edwards, D.D.S.

  • General Practice Dentistry
  • San Mateo, CA
National Provider Identifier
1902905532
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30069 Issued in CA
Practice address
324 N San Mateo Dr
Suite 1
San Mateo, CA 94401-2514
Phone
(650) 342-9571
Fax
(650) 342-9678
NPI assigned
Sep 21, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 30069 CA Primary

Addresses

Primary practice location

324 N San Mateo Dr
Suite 1
San Mateo, CA 94401-2514

Mailing address

324 N San Mateo Dr
Suite 1
San Mateo, CA 94401-2514
Phone (650) 342-9571

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160628001725 CA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 4981995685

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30069CAMDCounseling Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
M.Jamali DMD, P.Dokhanchi DDS, Apc General Practice Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902905532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 N SAN MATEO DR",
            "address_2": "SUITE 1",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944012514",
            "telephone_number": "650-342-9571",
            "fax_number": "650-342-9678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 N SAN MATEO DR",
            "address_2": "SUITE 1",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944012514",
            "telephone_number": "650-342-9571",
            "fax_number": "650-342-9678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "LYNN",
        "middle_name": "MARIE",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "30069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Mateo, CA

Sources for this page

Verify at the official NPI Registry.