Provider Demographics
NPI:1114988185
Name:MIDGLEY, LYNNE L (DDS)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:L
Last Name:MIDGLEY
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 1:4200 WEST CONEJOS PLACE
Mailing Address - Street 2:SUITE LL5
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204
Mailing Address - Country:US
Mailing Address - Phone:720-956-0310
Mailing Address - Fax:720-956-0313
Practice Address - Street 1:4200 W. CONEJOS PL.
Practice Address - Street 2:SUITE LL5
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204
Practice Address - Country:US
Practice Address - Phone:720-956-0310
Practice Address - Fax:720-956-0310
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81282711Medicare ID - Type Unspecified