Provider Demographics
NPI:1235456161
Name:LYNCH, PETER R (DDS)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:R
Last Name:LYNCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HIGHWAY 25 S
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-4325
Mailing Address - Country:US
Mailing Address - Phone:763-682-2363
Mailing Address - Fax:
Practice Address - Street 1:1000 HIGHWAY 25 S
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-4325
Practice Address - Country:US
Practice Address - Phone:763-682-2363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12837122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist