Provider Demographics
NPI:1104109941
Name:LINDSTEN FAMILY DENTISTRY
Entity type:Organization
Organization Name:LINDSTEN FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:P
Authorized Official - Last Name:LINDSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-398-3900
Mailing Address - Street 1:1437 S BELL SCHOOL RD
Mailing Address - Street 2:#2
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-1405
Mailing Address - Country:US
Mailing Address - Phone:815-398-3900
Mailing Address - Fax:
Practice Address - Street 1:1437 S BELL SCHOOL RD
Practice Address - Street 2:#2
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-1405
Practice Address - Country:US
Practice Address - Phone:815-398-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty