Provider Demographics
NPI:1396874996
Name:LINDSAY, JON C (DDS)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:C
Last Name:LINDSAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JONATHAN
Other - Middle Name:CLAIR
Other - Last Name:LINDSAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:34225 N 27TH DRIVE
Mailing Address - Street 2:#241
Mailing Address - City:PHEONIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6091
Mailing Address - Country:US
Mailing Address - Phone:623-439-2280
Mailing Address - Fax:623-289-2578
Practice Address - Street 1:1751 STOCKTON HILL RD
Practice Address - Street 2:STE A
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-6601
Practice Address - Country:US
Practice Address - Phone:928-289-3738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD06624122300000X
IL019026950122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9181500Medicaid