Healthcare Provider Details

I. General information

NPI: 1497964068
Provider Name (Legal Business Name): EDWARD J. LYNCH, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 5TH ST
RAPID CITY SD
57701-5428
US

IV. Provider business mailing address

2220 5TH ST
RAPID CITY SD
57701-5428
US

V. Phone/Fax

Practice location:
  • Phone: 605-343-5925
  • Fax: 605-399-2555
Mailing address:
  • Phone: 605-343-5925
  • Fax: 605-399-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD J. LYNCH
Title or Position: PRESIDENT
Credential: DDS
Phone: 605-343-5925