Provider Demographics
NPI:1134276330
Name:LYNCH, GAVIN PATRIC (DDS)
Entity type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:PATRIC
Last Name:LYNCH
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 1:704 SCARBORO DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13209-2247
Mailing Address - Country:US
Mailing Address - Phone:315-488-0908
Mailing Address - Fax:
Practice Address - Street 1:309 KASSON RD
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2200
Practice Address - Country:US
Practice Address - Phone:315-487-1591
Practice Address - Fax:315-487-4363
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0480951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice