Provider Demographics
NPI:1518233691
Name:MICKEY W. LINDSEY D.D.S.,P.A.
Entity Type:Organization
Organization Name:MICKEY W. LINDSEY D.D.S.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICKEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-836-7860
Mailing Address - Street 1:1920 W WASHINGTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-3134
Mailing Address - Country:US
Mailing Address - Phone:870-836-7860
Mailing Address - Fax:
Practice Address - Street 1:1920 W WASHINGTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-3134
Practice Address - Country:US
Practice Address - Phone:870-836-7860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2816261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127323769Medicaid
T 95794Medicare UPIN