Healthcare Provider Details

I. General information

NPI: 1558034884
Provider Name (Legal Business Name): LINDSEY JO HOTTEL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 HOFF ST BLDG 9240
FORT BENNING GA
31905-5645
US

IV. Provider business mailing address

606 PERKINS ST
FORT BENNING GA
31905-6518
US

V. Phone/Fax

Practice location:
  • Phone: 706-544-2052
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2015011484
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: