Provider Demographics
NPI:1093152845
Name:ANDERSON, LINDSEY CLARK (DMD)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:CLARK
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 MCEVER RD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-2237
Mailing Address - Country:US
Mailing Address - Phone:770-534-1816
Mailing Address - Fax:
Practice Address - Street 1:7316 SPOUT SPRINGS RD STE 204
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-5620
Practice Address - Country:US
Practice Address - Phone:770-853-1890
Practice Address - Fax:770-741-0138
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist