Healthcare Provider Details

I. General information

NPI: 1346506011
Provider Name (Legal Business Name): LINDSEY LEE TISCHER MDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2012
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 PLEASANT AVE
PARK RAPIDS MN
56470-1432
US

IV. Provider business mailing address

1278 BAY RIDGE DR
DETROIT LAKES MN
56501-4911
US

V. Phone/Fax

Practice location:
  • Phone: 218-732-4436
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code125J00000X
TaxonomyDental Therapist
License NumberDT12
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: