Healthcare Provider Details

I. General information

NPI: 1720076508
Provider Name (Legal Business Name): KATHLEEN ANNE LINDELL D.D.S., M.S.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 BARNES BLVD
MCCHORD AFB WA
98438-1303
US

IV. Provider business mailing address

2859 HANNEN ST
DUPONT WA
98327-8747
US

V. Phone/Fax

Practice location:
  • Phone: 250-982-5505
  • Fax:
Mailing address:
  • Phone: 235-964-2259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5454
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: