Provider Demographics
NPI:1851308688
Name:LINDBLOM, STEPHEN CHARLES (DDS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:CHARLES
Last Name:LINDBLOM
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 1:3221 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062
Mailing Address - Country:US
Mailing Address - Phone:650-365-2683
Mailing Address - Fax:650-365-2684
Practice Address - Street 1:3221 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062
Practice Address - Country:US
Practice Address - Phone:650-365-2683
Practice Address - Fax:650-365-2684
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48949122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist