Provider Demographics
NPI:1164663191
Name:LYNCH, MATTHEW AARON (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:AARON
Last Name:LYNCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:IL
Mailing Address - Zip Code:62691-1519
Mailing Address - Country:US
Mailing Address - Phone:217-452-3057
Mailing Address - Fax:217-452-7245
Practice Address - Street 1:331 S MAIN ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:IL
Practice Address - Zip Code:62691-1519
Practice Address - Country:US
Practice Address - Phone:217-452-3057
Practice Address - Fax:217-452-7245
Is Sole Proprietor?:No
Enumeration Date:2009-03-21
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.027732122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019027732Medicaid