Healthcare Provider Details

I. General information

NPI: 1083418008
Provider Name (Legal Business Name): LINDSAY MORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 SANDHILL DR STE 101
MIDDLETOWN DE
19709-5861
US

IV. Provider business mailing address

501 W 14TH ST
WILMINGTON DE
19801-1013
US

V. Phone/Fax

Practice location:
  • Phone: 302-376-9159
  • Fax:
Mailing address:
  • Phone: 302-733-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberG1-0011661
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: