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General NPI Number Information
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NPI Number | 1093910267
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Entity Type | Individual
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Provider Name | LYNDON MACKAY
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Gender | Male
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3550 S 4800 W STE J
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City | WEST VALLEY CITY
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State | UT
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Zip | 84120-2959
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Country | US
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Telephone | 801-969-3025
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Fax |
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Provider Business Mailing Address
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Address Line | 31 LAKE RIDGE DR
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City | KAYSVILLE
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State | UT
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Zip | 84037-9655
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Country | US
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Telephone | 801-451-5073
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 134443
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License Number State | UT
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