Healthcare Provider Details

I. General information

NPI: 1104106566
Provider Name (Legal Business Name): LINDSAY ELIZABETH TYMON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 OLD DOMINION DR STE 240
MC LEAN VA
22101-4504
US

IV. Provider business mailing address

4428 16TH ST N
ARLINGTON VA
22207-2130
US

V. Phone/Fax

Practice location:
  • Phone: 703-734-2750
  • Fax:
Mailing address:
  • Phone: 717-799-4312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401413245
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: