Healthcare Provider Details

I. General information

NPI: 1881099117
Provider Name (Legal Business Name): LYNSEY LINDSTROM DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 S DENALI ST SUITE B
PALMER AK
99645-6464
US

IV. Provider business mailing address

561 S DENALI ST SUITE B
PALMER AK
99645-6464
US

V. Phone/Fax

Practice location:
  • Phone: 907-745-8122
  • Fax: 907-745-8120
Mailing address:
  • Phone: 907-745-8122
  • Fax: 907-745-8120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LYNSEY LINDSTROM
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 907-745-8122