Provider Demographics
NPI:1689963225
Name:LINDER, PAMELA JACKSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JACKSON
Last Name:LINDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:BETH
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1121 W MICHIGAN ST
Mailing Address - Street 2:FACULTY PRACTICE - IUSD
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5211
Mailing Address - Country:US
Mailing Address - Phone:317-247-5628
Mailing Address - Fax:
Practice Address - Street 1:1121 W MICHIGAN ST
Practice Address - Street 2:FACULTY PRACTICE - IUSD
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5211
Practice Address - Country:US
Practice Address - Phone:317-274-5628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012233A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice