Provider Demographics
NPI:1205080843
Name:LYNCH, PAMELA JEAN (RDH)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:LYNCH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8495 SW HEMLOCK ST APT C
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5837
Mailing Address - Country:US
Mailing Address - Phone:541-643-4152
Mailing Address - Fax:
Practice Address - Street 1:301 SW LINCOLN ST APT 1214
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5032
Practice Address - Country:US
Practice Address - Phone:541-643-4152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIL 60127826124Q00000X
ORCOS-FT-10125043247200000X
ORH4846124Q00000X
CARDH22343124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other