Provider Demographics
NPI:1346844271
Name:MACKLEY, LINDSEY (RDH)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:MACKLEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3204
Mailing Address - Country:US
Mailing Address - Phone:301-461-6039
Mailing Address - Fax:
Practice Address - Street 1:811 OAK HILL AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3210
Practice Address - Country:US
Practice Address - Phone:301-461-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6079124Q00000X
PADH070430124Q00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No124Q00000XDental ProvidersDental Hygienist