Provider Demographics
NPI:1144584319
Name:JACKSON, LINDSEY DAWN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:DAWN
Last Name:JACKSON
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 1:22 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03581-1604
Mailing Address - Country:US
Mailing Address - Phone:603-466-5015
Mailing Address - Fax:
Practice Address - Street 1:22 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:NH
Practice Address - Zip Code:03581-1604
Practice Address - Country:US
Practice Address - Phone:603-466-5015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3999122300000X
MADN1856035122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist