Provider Demographics
NPI:1629320296
Name:HALL, LINDSEY JORDAN (RDH)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:JORDAN
Last Name:HALL
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 1:2818 S OUTER BELT RD
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:64075-8291
Mailing Address - Country:US
Mailing Address - Phone:816-267-0959
Mailing Address - Fax:
Practice Address - Street 1:811- A SOUTH 13 HIGHWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067
Practice Address - Country:US
Practice Address - Phone:660-259-3823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012018403124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist