Provider Demographics
NPI:1417038589
Name:LINDSAY FAMILY DENTISTRY
Entity Type:Organization
Organization Name:LINDSAY FAMILY DENTISTRY
Other - Org Name:STEVEN D. PRACHT DDS PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRACHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-756-4093
Mailing Address - Street 1:102 SW 7TH ST.
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:OK
Mailing Address - Zip Code:73052
Mailing Address - Country:US
Mailing Address - Phone:405-756-4093
Mailing Address - Fax:405-756-4093
Practice Address - Street 1:102 SW 7TH ST.
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:OK
Practice Address - Zip Code:73052
Practice Address - Country:US
Practice Address - Phone:405-756-4093
Practice Address - Fax:405-756-4093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK41301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200091480 AMedicaid