Provider Demographics
NPI:1609002450
Name:CAMPBELL, LINDSAY MARIE (RDH)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 W CEDAR POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5582
Mailing Address - Country:US
Mailing Address - Phone:208-918-1953
Mailing Address - Fax:855-544-0967
Practice Address - Street 1:635 W CEDAR POINTE WAY
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5582
Practice Address - Country:US
Practice Address - Phone:208-918-1953
Practice Address - Fax:855-544-0967
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPENDING124Q00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID433412-551OtherIDAHO LICENSE PENDING FILE CODE