Provider Demographics
NPI:1235491713
Name:JONES SANDIFER, LYNDSEY C (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:LYNDSEY
Middle Name:C
Last Name:JONES SANDIFER
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:DR
Other - First Name:LYNDSEY
Other - Middle Name:CAMILLE
Other - Last Name:SANDIFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MSD
Mailing Address - Street 1:219 GARDEN PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-5511
Mailing Address - Country:US
Mailing Address - Phone:601-853-1307
Mailing Address - Fax:601-853-9872
Practice Address - Street 1:219 GARDEN PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-5511
Practice Address - Country:US
Practice Address - Phone:601-853-1307
Practice Address - Fax:601-853-9872
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3544-101223G0001X
MSOR-458-121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08934025Medicaid