Provider Demographics
NPI:1295027621
Name:LINDQUIST, THERESA JEANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:JEANNE
Last Name:LINDQUIST
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 1:2411 GREAR ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2702
Mailing Address - Country:US
Mailing Address - Phone:503-363-0622
Mailing Address - Fax:
Practice Address - Street 1:2411 GREAR ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2702
Practice Address - Country:US
Practice Address - Phone:503-363-0622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD95561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice