Provider Demographics
NPI:1376708644
Name:LINDSAY, SUSAN E (REGISTERED DENTAL HY)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:LINDSAY
Suffix:
Gender:F
Credentials:REGISTERED DENTAL HY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PORTLAND ST
Mailing Address - Street 2:HEALTHCARE FOR THE HOMELESS DENTAL CLINIC
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2912
Mailing Address - Country:US
Mailing Address - Phone:207-874-8983
Mailing Address - Fax:
Practice Address - Street 1:1145 BRIGHTON AVE
Practice Address - Street 2:BARRON CENTER
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-541-6500
Practice Address - Fax:207-541-6555
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2130124Q00000X
MA5857124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist