Provider Demographics
NPI:1558408658
Name:TAKEDA, LINDSAY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:S
Last Name:TAKEDA
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 1:1394 E ALLUVIAL AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2608
Mailing Address - Country:US
Mailing Address - Phone:559-226-7464
Mailing Address - Fax:559-226-5309
Practice Address - Street 1:1394 E ALLUVIAL AVE
Practice Address - Street 2:STE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2608
Practice Address - Country:US
Practice Address - Phone:559-226-7464
Practice Address - Fax:559-226-5309
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice