MEDICARE: DR. JON C LINDSAY D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D06624	AZ
2	122300000X	Dentist	019026950	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396874996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON C LINDSAY D.D.S

Provider Business Mailing Address
First Line	:	34225 N 27TH DRIVE
Second Line	:	#241
City	:	PHEONIX
State	:	AZ
Zip	:	85085-6091
Country	:	US
Telephone Number	:	623-439-2280
Fax Number	:	623-289-2578

Provider Business Practice Location Address
First Line	:	1751 STOCKTON HILL RD
Second Line	:	STE A
City	:	KINGMAN
State	:	AZ
Zip	:	86401-6601
Country	:	US
Telephone Number	:	928-289-3738
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	06/24/2021

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Directions to “ DR. JON C LINDSAY D.D.S” Practice Location

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