Healthcare Provider Details

I. General information

NPI: 1841980950
Provider Name (Legal Business Name): GRACYN LINDBORG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19507 INTERSTATE 45 STE 522
SPRING TX
77388-6072
US

IV. Provider business mailing address

3015 WESLAYAN ST APT 5048
HOUSTON TX
77027-5788
US

V. Phone/Fax

Practice location:
  • Phone: 281-602-0880
  • Fax:
Mailing address:
  • Phone: 407-864-2385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number42473
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: