Provider Demographics
NPI:1992186043
Name:PEDERSON, LINDSEY MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:MARIE
Last Name:PEDERSON
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 1:221 S JEFFERS ST
Mailing Address - Street 2:1
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5371
Mailing Address - Country:US
Mailing Address - Phone:308-534-4040
Mailing Address - Fax:308-534-1087
Practice Address - Street 1:221 S JEFFERS ST
Practice Address - Street 2:1
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5371
Practice Address - Country:US
Practice Address - Phone:308-534-4040
Practice Address - Fax:308-534-1087
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE72181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE7218OtherSTATE LICENSE