Provider Demographics
NPI:1003951732
Name:JOHNSON, LINDSAY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LINDSAY
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:925 SECRET RIVER DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3465
Mailing Address - Country:US
Mailing Address - Phone:916-905-0345
Mailing Address - Fax:888-678-2930
Practice Address - Street 1:925 SECRET RIVER DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3465
Practice Address - Country:US
Practice Address - Phone:916-905-0345
Practice Address - Fax:888-678-2930
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA502791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA80-0580684OtherEIN