Healthcare Provider Details

I. General information

NPI: 1861759508
Provider Name (Legal Business Name): DAVID M LINDLEY, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 W GORE BLVD
LAWTON OK
73501-3605
US

IV. Provider business mailing address

1315 W GORE BLVD
LAWTON OK
73501-3605
US

V. Phone/Fax

Practice location:
  • Phone: 580-353-7037
  • Fax: 580-353-7039
Mailing address:
  • Phone: 580-353-7037
  • Fax: 580-353-7039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3235
License Number StateOK

VIII. Authorized Official

Name: DR. DAVID MICHAEL LINDLEY
Title or Position: OWNER
Credential: DDS
Phone: 580-353-7037