Healthcare Provider Details

I. General information

NPI: 1851173066
Provider Name (Legal Business Name): DANA LORENE LINDAMOOD RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BLUFF CITY HWY
BRISTOL TN
37620-4215
US

IV. Provider business mailing address

224 COLLINGWOOD DR
BRISTOL TN
37620-3317
US

V. Phone/Fax

Practice location:
  • Phone: 423-764-2166
  • Fax:
Mailing address:
  • Phone: 423-844-0198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number4118
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: