Healthcare Provider Details

I. General information

NPI: 1689366791
Provider Name (Legal Business Name): DONALD GRIFFIN LYNN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6089 W 11800 S
HERRIMAN UT
84096
US

IV. Provider business mailing address

10894 S RIVER FRONT PKWY
SOUTH JORDAN UT
84095-5609
US

V. Phone/Fax

Practice location:
  • Phone: 205-617-4271
  • Fax:
Mailing address:
  • Phone: 205-617-4271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14278980-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: