Healthcare Provider Details

I. General information

NPI: 1134685407
Provider Name (Legal Business Name): LINDSEY LEE TAYLOR RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 NE 10TH AVE
PAYETTE ID
83661-5422
US

IV. Provider business mailing address

1501 NE 10TH AVE
PAYETTE ID
83661-5422
US

V. Phone/Fax

Practice location:
  • Phone: 208-642-9379
  • Fax: 208-642-5004
Mailing address:
  • Phone: 208-642-9379
  • Fax: 208-642-5004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH3141
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: