Provider Demographics
NPI:1215768536
Name:AHEARN, LINDSEY (RDH)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:AHEARN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5663 EAGLE LOOP
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-8996
Mailing Address - Country:US
Mailing Address - Phone:360-560-7791
Mailing Address - Fax:
Practice Address - Street 1:1105 14TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3016
Practice Address - Country:US
Practice Address - Phone:360-916-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60252577124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty