Basic Information
| Provider Information | |||||||||
| NPI: | 1275075244 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYNCH | ||||||||
| FirstName: | SUMMER | ||||||||
| MiddleName: | MICHELE | ||||||||
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| Credential: | DHAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1529 | ||||||||
| Address2: | |||||||||
| City: | HAINES | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998271529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077666372 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 216 DALTON STREET | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | HAINES | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077666372 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2016 | ||||||||
| LastUpdateDate: | 11/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 125J00000X | 16-139-DHA | AK | Y | Dental Providers | Dental Therapist |
ID Information
| ID | Type | State | Issuer | Description | 16-139-DHA | 01 | AK | CHAP CERTIFICATION BOARD | OTHER |