Provider Demographics
NPI:1417097239
Name:LINDEMAN, LISA RUTH (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:RUTH
Last Name:LINDEMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 FLINDT DRIVE
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-3204
Mailing Address - Country:US
Mailing Address - Phone:712-732-4036
Mailing Address - Fax:
Practice Address - Street 1:906 FLINDT DRIVE
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-3204
Practice Address - Country:US
Practice Address - Phone:712-732-4036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0053645Medicaid