Provider Demographics
NPI:1578796405
Name:LYNCH, KELLY MIDDLETON (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MIDDLETON
Last Name:LYNCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WHITLEY
Mailing Address - State:IN
Mailing Address - Zip Code:46787
Mailing Address - Country:US
Mailing Address - Phone:260-723-6632
Mailing Address - Fax:260-723-6185
Practice Address - Street 1:202 STATE ST
Practice Address - Street 2:
Practice Address - City:SO. WHITLEY
Practice Address - State:IN
Practice Address - Zip Code:46787
Practice Address - Country:US
Practice Address - Phone:260-723-6632
Practice Address - Fax:260-723-6185
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN8585122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist