Provider Demographics
NPI:1154768513
Name:BRANGWYNNE, LINDSEY JOAN (DMD)
Entity type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:JOAN
Last Name:BRANGWYNNE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7646
Mailing Address - Country:US
Mailing Address - Phone:207-883-4285
Mailing Address - Fax:207-883-9891
Practice Address - Street 1:500 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7646
Practice Address - Country:US
Practice Address - Phone:207-883-4285
Practice Address - Fax:207-883-9891
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4303122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist