Provider Demographics
NPI:1215990650
Name:LYNCH, LISA M (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:LYNCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 GODWIN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1969
Mailing Address - Country:US
Mailing Address - Phone:201-444-9898
Mailing Address - Fax:201-444-6079
Practice Address - Street 1:44 GODWIN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1969
Practice Address - Country:US
Practice Address - Phone:201-444-9898
Practice Address - Fax:201-444-6079
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI101969402122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244202Medicaid