MEDICARE: DR. GEORGE THOMAS LYNCH IV DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	2342700	NJ
2	1223P0221X	Pediatric Dentistry	DS036787	PA

General Provider Information

NPI Number	:	1548464761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE THOMAS LYNCH IV DMD

Provider Business Mailing Address
First Line	:	1101 WASHINGTON AVE
Second Line	:	V1
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-3839
Country	:	US
Telephone Number	:	267-909-9551
Fax Number	:	267-909-9761

Provider Business Practice Location Address
First Line	:	1352 SOUTH ST
Second Line	:	C5
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-1858
Country	:	US
Telephone Number	:	267-909-9551
Fax Number	:	267-909-9761

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	03/29/2011

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