Provider Demographics
NPI:1881957264
Name:CARBALLO, LINDSEY LOFTON (DMD)
Entity type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:LOFTON
Last Name:CARBALLO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7885 NORMANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-6640
Mailing Address - Country:US
Mailing Address - Phone:904-783-1633
Mailing Address - Fax:904-783-2046
Practice Address - Street 1:7885 NORMANDY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-6640
Practice Address - Country:US
Practice Address - Phone:904-783-1633
Practice Address - Fax:904-783-2046
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL197101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice