Provider Demographics
NPI:1093910267
Name:MACKAY, LYNDON
Entity Type:Individual
Prefix:
First Name:LYNDON
Middle Name:
Last Name:MACKAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 LAKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-9655
Mailing Address - Country:US
Mailing Address - Phone:801-451-5073
Mailing Address - Fax:
Practice Address - Street 1:3550 S 4800 W STE J
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2959
Practice Address - Country:US
Practice Address - Phone:801-969-3025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT134443122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist