Provider Demographics
NPI:1053339523
Name:BARD, LYNDA ILENE (DMD)
Entity type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:ILENE
Last Name:BARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FRANKLIN TOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1238
Mailing Address - Country:US
Mailing Address - Phone:267-519-9694
Mailing Address - Fax:888-416-2794
Practice Address - Street 1:2 FRANKLIN TOWN BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1238
Practice Address - Country:US
Practice Address - Phone:267-519-9694
Practice Address - Fax:888-416-2794
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031548L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist