Healthcare Provider Details

I. General information

NPI: 1285447086
Provider Name (Legal Business Name): LINDSEY THOMACK RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 S 1ST ST # 276
MILWAUKEE WI
53204-2405
US

IV. Provider business mailing address

1314 S 1ST ST # 276
MILWAUKEE WI
53204-2405
US

V. Phone/Fax

Practice location:
  • Phone: 407-375-3003
  • Fax: 800-863-5373
Mailing address:
  • Phone: 407-375-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1003329
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: