Provider Demographics
NPI:1922354398
Name:PENCHAN, LINDSAY (DDS)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:
Last Name:PENCHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111B GLENWICK LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3010 STATE HIGHWAY 121
Practice Address - Street 2:SUITE 300
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-5823
Practice Address - Country:US
Practice Address - Phone:817-571-3368
Practice Address - Fax:817-571-3369
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX280371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice