Healthcare Provider Details

I. General information

NPI: 1225381007
Provider Name (Legal Business Name): ELIZA LINDQUIST D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 E BIDWELL ST
FOLSOM CA
95630-3524
US

IV. Provider business mailing address

1310 E BIDWELL ST
FOLSOM CA
95630-3524
US

V. Phone/Fax

Practice location:
  • Phone: 916-984-6200
  • Fax:
Mailing address:
  • Phone: 916-984-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number103295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: