Provider Demographics
NPI:1255467767
Name:LINDELL, STEPHEN BURDETTE (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BURDETTE
Last Name:LINDELL
Suffix:
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 1:6416 W HIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-2203
Mailing Address - Country:US
Mailing Address - Phone:773-775-3164
Mailing Address - Fax:773-775-2409
Practice Address - Street 1:6416 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-2203
Practice Address - Country:US
Practice Address - Phone:773-775-3164
Practice Address - Fax:773-775-2409
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01911903122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist