Provider Demographics
NPI:1710112172
Name:WURTZEL, LINDSEY ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:ELIZABETH
Last Name:WURTZEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LINDSEY
Other - Middle Name:ELIZABETH
Other - Last Name:DOUVILLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4554 WASHTENAW AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1000
Mailing Address - Country:US
Mailing Address - Phone:734-971-2675
Mailing Address - Fax:734-971-9653
Practice Address - Street 1:4554 WASHTENAW AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1000
Practice Address - Country:US
Practice Address - Phone:734-971-2675
Practice Address - Fax:734-971-9653
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist