Healthcare Provider Details

I. General information

NPI: 1427090810
Provider Name (Legal Business Name): JOHN LINDSLY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 LA HWY 1
INNIS LA
70747-0089
US

IV. Provider business mailing address

6450 LA HIGHWAY 1
BATCHELOR LA
70715-3212
US

V. Phone/Fax

Practice location:
  • Phone: 225-492-3775
  • Fax: 225-492-3782
Mailing address:
  • Phone: 225-492-3775
  • Fax: 225-492-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1997
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: