Provider Demographics
NPI:1912003302
Name:LINDGREN, PAUL WILLARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WILLARD
Last Name:LINDGREN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33620 SAINT SHARBEL CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-3732
Mailing Address - Country:US
Mailing Address - Phone:440-937-3210
Mailing Address - Fax:
Practice Address - Street 1:25101 DETROIT RD
Practice Address - Street 2:STE #445
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2552
Practice Address - Country:US
Practice Address - Phone:440-871-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice