Healthcare Provider Details

I. General information

NPI: 1538152806
Provider Name (Legal Business Name): THOMAS JAMES LYNCH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 BRIARGATE BLVD STE C
COLORADO SPRINGS CO
80920-3452
US

IV. Provider business mailing address

1675 BRIARGATE BLVD STE C
COLORADO SPRINGS CO
80920-3452
US

V. Phone/Fax

Practice location:
  • Phone: 719-598-7797
  • Fax: 719-598-7077
Mailing address:
  • Phone: 719-598-7797
  • Fax: 719-598-7077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberCO7139
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: