Provider Demographics
NPI:1932320017
Name:LYNCH, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 GUTHRIE RD
Mailing Address - Street 2:STE 180
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5961
Mailing Address - Country:US
Mailing Address - Phone:972-226-1003
Mailing Address - Fax:
Practice Address - Street 1:2306 GUTHRIE RD
Practice Address - Street 2:STE 180
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5961
Practice Address - Country:US
Practice Address - Phone:972-226-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13328124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist