Provider Demographics
NPI:1609036888
Name:DAHLSTROM, LYNDSEY ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LYNDSEY
Middle Name:ANN
Last Name:DAHLSTROM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 PLAZA AVE
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-6749
Mailing Address - Country:US
Mailing Address - Phone:478-231-8190
Mailing Address - Fax:
Practice Address - Street 1:421 PLAZA AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6749
Practice Address - Country:US
Practice Address - Phone:478-374-4716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0137431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice