Provider Demographics
NPI:1699828616
Name:LYNCH, RONALD R (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:R
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 1:1515 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1150
Mailing Address - Country:US
Mailing Address - Phone:217-245-1211
Mailing Address - Fax:217-291-0401
Practice Address - Street 1:1515 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1150
Practice Address - Country:US
Practice Address - Phone:217-245-1211
Practice Address - Fax:217-291-0401
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-162901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice