Provider Demographics
NPI:1891104584
Name:GARDNER, LINDSEY RAE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:RAE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:067-640-5022
Mailing Address - Fax:206-764-0516
Practice Address - Street 1:1920 100TH ST SE STE C2
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3832
Practice Address - Country:US
Practice Address - Phone:425-249-0770
Practice Address - Fax:425-249-0771
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX303761223G0001X
FLDN 206601223G0001X
WADE60755446122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice