Provider Demographics
NPI:1154807154
Name:LINDBERG, KATELYN (DDS)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 DOGWOOD LN STE D
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-1239
Mailing Address - Country:US
Mailing Address - Phone:434-634-5157
Mailing Address - Fax:434-634-5158
Practice Address - Street 1:307 DOGWOOD LN STE D
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1239
Practice Address - Country:US
Practice Address - Phone:434-634-5157
Practice Address - Fax:434-634-5158
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014161891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice