Provider Demographics
NPI:1285447086
Name:THOMACK, LINDSEY (RDH)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:THOMACK
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 1:1314 S 1ST ST # 276
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-2405
Mailing Address - Country:US
Mailing Address - Phone:407-375-3003
Mailing Address - Fax:
Practice Address - Street 1:1314 S 1ST ST # 276
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-2405
Practice Address - Country:US
Practice Address - Phone:407-375-3003
Practice Address - Fax:800-863-5373
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1003329124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist