1376708644 NPI number — MS. SUSAN E LINDSAY REGISTERED DENTAL HY

Table of content: MS. SUSAN E LINDSAY REGISTERED DENTAL HY (NPI 1376708644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376708644 NPI number — MS. SUSAN E LINDSAY REGISTERED DENTAL HY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINDSAY
Provider First Name:
SUSAN
Provider Middle Name:
E
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED DENTAL HY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376708644
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 PORTLAND ST
Provider Second Line Business Mailing Address:
HEALTHCARE FOR THE HOMELESS DENTAL CLINIC
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04101-2912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-874-8983
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1145 BRIGHTON AVE
Provider Second Line Business Practice Location Address:
BARRON CENTER
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-541-6500
Provider Business Practice Location Address Fax Number:
207-541-6555
Provider Enumeration Date:
07/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  2130 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 124Q00000X , with the licence number: 5857 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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