Provider Demographics
NPI:1104480417
Name:LINDON ENDSLEY DDS
Entity type:Organization
Organization Name:LINDON ENDSLEY DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-799-9540
Mailing Address - Street 1:2098 N VALLEY MILLS DR STE A
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-2585
Mailing Address - Country:US
Mailing Address - Phone:254-799-9540
Mailing Address - Fax:254-751-0214
Practice Address - Street 1:2098 N VALLEY MILLS DR STE A
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2585
Practice Address - Country:US
Practice Address - Phone:254-799-9540
Practice Address - Fax:254-751-0214
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SE SMILE BY DESIGN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-23
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty