Provider Demographics
NPI:1891888202
Name:LYNCH, JOHN THOMAS (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
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 1:22 MULBERRY ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-5741
Mailing Address - Country:US
Mailing Address - Phone:845-343-6908
Mailing Address - Fax:845-343-5850
Practice Address - Street 1:22 MULBERRY ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-5741
Practice Address - Country:US
Practice Address - Phone:845-343-6908
Practice Address - Fax:845-343-5850
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0446321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice