Provider Demographics
NPI:1174818678
Name:LYNCH, SAMANTHA J
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:LYNCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WILDWOOD GDNS
Mailing Address - Street 2:APT A2
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2308
Mailing Address - Country:US
Mailing Address - Phone:516-617-8787
Mailing Address - Fax:
Practice Address - Street 1:525 W END AVE
Practice Address - Street 2:SUITE 1G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3267
Practice Address - Country:US
Practice Address - Phone:212-874-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist