Provider Demographics
NPI:1568547693
Name:MUTCH, LYNN ANDREW (DDS)
Entity Type:Individual
Prefix:MR
First Name:LYNN
Middle Name:ANDREW
Last Name:MUTCH
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 1:1212 E MAIN STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4113
Mailing Address - Country:US
Mailing Address - Phone:626-282-2552
Mailing Address - Fax:626-282-0111
Practice Address - Street 1:1212 E MAIN STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4113
Practice Address - Country:US
Practice Address - Phone:626-282-2552
Practice Address - Fax:626-282-0111
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28771122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist