Provider Demographics
NPI:1639426604
Name:COSTANTINO, LINDSAY ANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:ANNE
Last Name:COSTANTINO
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 1:10505 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2319
Mailing Address - Country:US
Mailing Address - Phone:310-475-0617
Mailing Address - Fax:
Practice Address - Street 1:10505 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2319
Practice Address - Country:US
Practice Address - Phone:310-475-0617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA601411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice