Provider Demographics
NPI:1295862753
Name:LINDAU, PAMELA T
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:T
Last Name:LINDAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 MILL ST
Mailing Address - Street 2:P.O. BOX 353
Mailing Address - City:RIVERTON
Mailing Address - State:CT
Mailing Address - Zip Code:06065-1204
Mailing Address - Country:US
Mailing Address - Phone:860-738-0795
Mailing Address - Fax:
Practice Address - Street 1:157 LITCHFIELD ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6427
Practice Address - Country:US
Practice Address - Phone:860-489-1328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003235124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1225196702OtherGROUP NPI #
CT003235OtherLICENSE #