Healthcare Provider Details

I. General information

NPI: 1891104584
Provider Name (Legal Business Name): LINDSEY RAE GARDNER D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 100TH ST SE STE C2
EVERETT WA
98208-3832
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 425-249-0770
  • Fax: 425-249-0771
Mailing address:
  • Phone: 67-640-5022
  • Fax: 206-764-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30376
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 20660
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60755446
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: