Healthcare Provider Details

I. General information

NPI: 1942342456
Provider Name (Legal Business Name): THOMAS J LYNCH DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 BRIARGATE BLVD STE C
COLORADO SPRINGS CO
80920-3416
US

IV. Provider business mailing address

1675 BRIARGATE BLVD STE C
COLORADO SPRINGS CO
80920-3416
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 Number7139
License Number StateCO

VIII. Authorized Official

Name: THOMAS JAMES LYNCH
Title or Position: PRESIDENT
Credential: DDS
Phone: 719-598-7797