Provider Demographics
NPI:1346506011
Name:TISCHER, LINDSEY LEE (MDT)
Entity Type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:LEE
Last Name:TISCHER
Suffix:
Gender:F
Credentials:MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1278 BAY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-4911
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1432
Practice Address - Country:US
Practice Address - Phone:218-732-4436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-07
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDT12125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist