Provider Demographics
NPI:1154808582
Name:LIND, TIMBREY (RDH)
Entity type:Individual
Prefix:MISS
First Name:TIMBREY
Middle Name:
Last Name:LIND
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:TIMBREY
Other - Middle Name:
Other - Last Name:LIND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:32069 LOBO CANYON RD
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-3422
Mailing Address - Country:US
Mailing Address - Phone:805-260-5877
Mailing Address - Fax:
Practice Address - Street 1:30200 AGOURA RD STE 270
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-5434
Practice Address - Country:US
Practice Address - Phone:805-260-5877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24275124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist