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General NPI Number Information
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NPI Number | 1891960753
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Entity Type | Organization
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Legal Business Name | RONALD R LYNCH DMD LTD
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 1515 W WALNUT ST
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City | JACKSONVILLE
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State | IL
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Zip | 62650-1150
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Country | US
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Telephone | 217-245-1211
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 W WALNUT ST
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City | JACKSONVILLE
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State | IL
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Zip | 62650-1150
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD R LYNCH
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Credential | DMD
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Telephone | 217-245-1211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 19-016290
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License Number State | IL
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