Provider Demographics
NPI:1356652614
Name:STATILE, LINDSAY ANDERSON (DDS)
Entity type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:ANDERSON
Last Name:STATILE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LINDSAY
Other - Middle Name:GREER
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:8218 SALTWOOD PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-8707
Mailing Address - Country:US
Mailing Address - Phone:252-671-9249
Mailing Address - Fax:
Practice Address - Street 1:3212 S WILMINGTON ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3538
Practice Address - Country:US
Practice Address - Phone:919-773-3002
Practice Address - Fax:919-773-8824
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC89821223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice