Provider Demographics
NPI:1063824753
Name:MCMAHAN, LINDSEY ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:ANNE
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4523 GRAND LAKE DR STE 208
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-4587
Mailing Address - Country:US
Mailing Address - Phone:330-881-5888
Mailing Address - Fax:
Practice Address - Street 1:8301 W RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5524
Practice Address - Country:US
Practice Address - Phone:216-706-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-024190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0109583Medicaid