Provider Demographics
NPI:1326325671
Name:LINDEGREN, CAROL ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL ANN
Middle Name:
Last Name:LINDEGREN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6927 BROCKTON AVE STE 1C
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3806
Mailing Address - Country:US
Mailing Address - Phone:951-682-8899
Mailing Address - Fax:951-682-8941
Practice Address - Street 1:6927 BROCKTON AVE STE 1C
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3806
Practice Address - Country:US
Practice Address - Phone:951-682-8899
Practice Address - Fax:951-682-8941
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADW031947122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist