Provider Demographics
NPI:1225129455
Name:LINDEBERG, MICHAEL THEODORE I (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THEODORE
Last Name:LINDEBERG
Suffix:I
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 1:212 N BUXTON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-2431
Mailing Address - Country:US
Mailing Address - Phone:515-961-0534
Mailing Address - Fax:
Practice Address - Street 1:212 N BUXTON ST
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-2431
Practice Address - Country:US
Practice Address - Phone:515-961-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8745122300000X
IA08581122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist