Provider Demographics
NPI:1447428248
Name:LINDBORG, DANIEL FREDERICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:FREDERICK
Last Name:LINDBORG
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 1:52303 EMMONS ROAD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-4294
Mailing Address - Country:US
Mailing Address - Phone:574-277-1551
Mailing Address - Fax:574-277-1552
Practice Address - Street 1:52303 EMMONS ROAD
Practice Address - Street 2:SUITE 17
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-4294
Practice Address - Country:US
Practice Address - Phone:574-277-1551
Practice Address - Fax:574-277-1552
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007260A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice