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General NPI Number Information
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NPI Number | 1356639710
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Entity Type | Organization
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Legal Business Name | FREDERICKSBURG DENTISTRY, PLLC
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 205 W WINDCREST ST SUITE 210
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-4479
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Country | US
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Telephone | 830-997-7232
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Fax | 830-997-8727
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Provider Business Mailing Address
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Address Line | 205 W WINDCREST ST SUITE 210
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-4479
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Country | US
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Telephone | 830-997-7232
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Fax | 830-997-8727
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JAY B LINDSAY
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Credential | DDS
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Telephone | 830-997-7232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 23926
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 10162
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License Number State | TX
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