Provider Demographics
NPI:1073783429
Name:LINDAHL, CLARENCE D (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:D
Last Name:LINDAHL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 TEQUESTA DR
Mailing Address - Street 2:SU 103
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-3087
Mailing Address - Country:US
Mailing Address - Phone:561-746-7600
Mailing Address - Fax:
Practice Address - Street 1:399 TEQUESTA DR
Practice Address - Street 2:SU 103
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-3087
Practice Address - Country:US
Practice Address - Phone:561-746-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-01
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4640122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist