Provider Demographics
NPI:1194148783
Name:CORBETT-REISER, LINDSAY ELIZABETH (LD)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:ELIZABETH
Last Name:CORBETT-REISER
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 NW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3603
Mailing Address - Country:US
Mailing Address - Phone:503-266-1800
Mailing Address - Fax:503-266-1800
Practice Address - Street 1:300 NW 3RD AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3603
Practice Address - Country:US
Practice Address - Phone:503-266-1800
Practice Address - Fax:503-266-1800
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDT-DO-10149646122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist