Healthcare Provider Details

I. General information

NPI: 1255905493
Provider Name (Legal Business Name): LINDSAY KATHLEEN GORMAN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 RUTGER ST
SAINT LOUIS MO
63104-1122
US

IV. Provider business mailing address

3 FRITZ RD
KILLINGWORTH CT
06419-1171
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-8363
  • Fax:
Mailing address:
  • Phone: 860-510-2263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2023016857
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: