Provider Demographics
NPI:1255856415
Name:JAYNE, LINDSAY JANE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:JANE
Last Name:JAYNE
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:LINDSAY
Other - Middle Name:JANE
Other - Last Name:DEACON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3000 ACRES RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-4902
Mailing Address - Country:US
Mailing Address - Phone:717-542-5924
Mailing Address - Fax:
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:717-542-5924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014157711223G0001X, 1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No1223G0001XDental ProvidersDentistGeneral Practice