Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 12007506A | IN |
N | 213EG0000X | General Practice | 12007506A | IN |
N | 1223P0700X | Prosthodontist | 12007506A | IN |
NPI | 1255428801 |
---|---|
Provider Name | Mr. Lynn Arlen Pestle |
First Address | Lafayette, IN 47904 |
Second Address | Lafayette, IN 47904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 08/07/2007 |