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General NPI Number Information
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NPI Number | 1104480417
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Entity Type | Organization
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Legal Business Name | LINDON ENDSLEY DDS
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 2098 N VALLEY MILLS DR STE A
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City | WACO
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State | TX
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Zip | 76710-2585
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Country | US
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Telephone | 254-799-9540
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Fax | 254-751-0214
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Provider Business Mailing Address
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Address Line | 2098 N VALLEY MILLS DR STE A
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City | WACO
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State | TX
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Zip | 76710-2585
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Country | US
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Telephone | 254-799-9540
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Fax | 254-751-0214
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MR. ANGEL MARIE MAYNARD
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Credential |
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Telephone | 254-799-9540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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