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General NPI Number Information
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NPI Number | 1962650150
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Entity Type | Organization
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Legal Business Name | LYNCH FAMILY DENTISTRY, P.C.
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 1515 W WALNUT ST BUILDING 5
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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 | 217-291-0401
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Provider Business Mailing Address
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Address Line | 1515 W WALNUT ST BUILDING 5
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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 | 217-291-0401
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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 | D.M.D.
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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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