Healthcare Provider Details

I. General information

NPI: 1689145369
Provider Name (Legal Business Name): LINDSAY MICHELLE CONSTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 W FIGARDEN DR # 101
FRESNO CA
93722-6025
US

IV. Provider business mailing address

4220 W FIGARDEN DR # 101
FRESNO CA
93722-6025
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-5200
  • Fax:
Mailing address:
  • Phone: 559-439-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number78152
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: