Provider Demographics
NPI:1417063140
Name:LINDAHL, MARTY WALTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTY
Middle Name:WALTER
Last Name:LINDAHL
Suffix:
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 1:2625 OLD NILES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-0553
Mailing Address - Country:US
Mailing Address - Phone:865-983-4444
Mailing Address - Fax:865-983-9484
Practice Address - Street 1:2625 OLD NILES FERRY RD
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-0553
Practice Address - Country:US
Practice Address - Phone:865-983-4444
Practice Address - Fax:865-983-9484
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 73821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice