Provider Demographics
NPI:1417020983
Name:YANCEY, LINDSAY CLEMENT JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:CLEMENT
Last Name:YANCEY
Suffix:JR
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 1:481 SHEPHERD ST
Mailing Address - Street 2:STRATFORD EXEC. PARK
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1627
Mailing Address - Country:US
Mailing Address - Phone:336-768-8850
Mailing Address - Fax:336-768-0135
Practice Address - Street 1:481 SHEPHERD ST
Practice Address - Street 2:STRATFORD EXEC. PARK
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1627
Practice Address - Country:US
Practice Address - Phone:336-768-8850
Practice Address - Fax:336-768-0135
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4458122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8999598Medicaid