Provider Demographics
NPI:1689806382
Name:POPOV, LINDSEY GAULKE (DMD)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:GAULKE
Last Name:POPOV
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:JEAN
Other - Last Name:GAULKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:17675 SW TUALATIN VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4443
Mailing Address - Country:US
Mailing Address - Phone:503-412-8842
Mailing Address - Fax:
Practice Address - Street 1:17675 SW TUALATIN VALLEY HWY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4443
Practice Address - Country:US
Practice Address - Phone:503-412-8842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9317122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist