Healthcare Provider Details

I. General information

NPI: 1023676475
Provider Name (Legal Business Name): JENNA ELIZABETH LINDSEY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1632 MILLERS GAP HWY
NEWLAND NC
28657-7957
US

IV. Provider business mailing address

PO BOX 101
LINVILLE NC
28646-0101
US

V. Phone/Fax

Practice location:
  • Phone: 828-733-2042
  • Fax:
Mailing address:
  • Phone: 828-260-9289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11406
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: