Healthcare Provider Details

I. General information

NPI: 1831300094
Provider Name (Legal Business Name): KELLY MICHELLE LINCOLN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2007
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E FEDERAL ST
MIDDLEBURG VA
20117
US

IV. Provider business mailing address

PO BOX 386
MIDDLEBURG VA
20118-0386
US

V. Phone/Fax

Practice location:
  • Phone: 540-687-6363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401413170
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: