Provider Demographics
NPI:1902378557
Name:ELLIS & LINDGREN ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:ELLIS & LINDGREN ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDGREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-750-9393
Mailing Address - Street 1:4600 JOHN MARR DR STE 401
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3310
Mailing Address - Country:US
Mailing Address - Phone:703-750-9393
Mailing Address - Fax:
Practice Address - Street 1:4600 JOHN MARR DR STE 401
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3310
Practice Address - Country:US
Practice Address - Phone:703-750-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty