Provider Demographics
NPI:1336826379
Name:LYNCH, SPENCER DAVID (DMD)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:DAVID
Last Name:LYNCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 DOLORES AVE
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-3808
Mailing Address - Country:US
Mailing Address - Phone:603-339-2128
Mailing Address - Fax:
Practice Address - Street 1:18 ELM ST
Practice Address - Street 2:
Practice Address - City:ANTRIM
Practice Address - State:NH
Practice Address - Zip Code:03440-3916
Practice Address - Country:US
Practice Address - Phone:603-588-6362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04846122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist