Provider Demographics
NPI:1073506390
Name:LINDHOUT, JEFFREY ALLEN (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALLEN
Last Name:LINDHOUT
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 44TH ST SW
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2349
Mailing Address - Country:US
Mailing Address - Phone:616-530-4710
Mailing Address - Fax:
Practice Address - Street 1:4330 44TH ST SW
Practice Address - Street 2:SUITE 106
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2349
Practice Address - Country:US
Practice Address - Phone:616-530-4710
Practice Address - Fax:616-530-0480
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010153361223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3057811Medicaid
MI3057820Medicaid
MIU56582Medicare UPIN