Provider Demographics
NPI:1679833123
Name:LINDEMANN, BERNADINE LYNN (EFDA)
Entity Type:Individual
Prefix:
First Name:BERNADINE
Middle Name:LYNN
Last Name:LINDEMANN
Suffix:
Gender:F
Credentials:EFDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 WESTERN CT
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-9557
Mailing Address - Country:US
Mailing Address - Phone:503-769-2625
Mailing Address - Fax:
Practice Address - Street 1:1030 WESTERN CT
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-9557
Practice Address - Country:US
Practice Address - Phone:503-769-2625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant