Healthcare Provider Details

I. General information

NPI: 1578655734
Provider Name (Legal Business Name): LINDA C. NIESSEN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTH TEXAS VA MEDICAL SYSTEM 4500 S. LANCASTER AVE
DALLAS TX
75216
US

IV. Provider business mailing address

3549 HAYNIE AVE
DALLAS TX
75205-1219
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-1097
  • Fax:
Mailing address:
  • Phone: 214-443-0323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17501
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: