Provider Demographics
NPI:1821170549
Name:ENDSLEY, LINDON SEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINDON
Middle Name:SEAN
Last Name:ENDSLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2098 N VALLEY MILLS DR STE A
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-2585
Mailing Address - Country:US
Mailing Address - Phone:254-799-9520
Mailing Address - Fax:254-300-9555
Practice Address - Street 1:2098 N VALLEY MILLS DR STE A
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2585
Practice Address - Country:US
Practice Address - Phone:254-799-9540
Practice Address - Fax:254-751-0214
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19559122300000X, 1223G0001X, 1223S0112X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1821170549OtherNPI