Healthcare Provider Details

I. General information

NPI: 1629320296
Provider Name (Legal Business Name): LINDSEY JORDAN HALL R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811- A SOUTH 13 HIGHWAY
LEXINGTON MO
64067
US

IV. Provider business mailing address

2818 S OUTER BELT RD
OAK GROVE MO
64075-8291
US

V. Phone/Fax

Practice location:
  • Phone: 660-259-3823
  • Fax:
Mailing address:
  • Phone: 816-267-0959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2012018403
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: