Provider Demographics
NPI:1326132697
Name:LINDQUIST, DON GLEN (DDS)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:GLEN
Last Name:LINDQUIST
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 1:9979 SUNFISH CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446
Mailing Address - Country:US
Mailing Address - Phone:805-238-2440
Mailing Address - Fax:805-238-2440
Practice Address - Street 1:#1 KINGS WAY
Practice Address - Street 2:AVENAL STATE PRISON
Practice Address - City:AVENAL
Practice Address - State:CA
Practice Address - Zip Code:93204
Practice Address - Country:US
Practice Address - Phone:559-386-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist