Provider Demographics
NPI:1306069216
Name:LYNCH, EDWARD JOSEPH (DDS)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOSEPH
Last Name:LYNCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-5428
Mailing Address - Country:US
Mailing Address - Phone:605-343-5925
Mailing Address - Fax:605-399-2555
Practice Address - Street 1:2220 5TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-5428
Practice Address - Country:US
Practice Address - Phone:605-343-5925
Practice Address - Fax:605-399-2555
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM6731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7805770Medicaid
CO105936OtherCO STATE DENTAL LICENSE
SDM673OtherSD STATE DENTAL LICENSE
SDM673OtherSD STATE DENTAL LICENSE