Provider Demographics
NPI:1346664554
Name:MODLIN, LINDSEY M (RDH)
Entity type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:M
Last Name:MODLIN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:M
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4234 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:GRANDI ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803
Mailing Address - Country:US
Mailing Address - Phone:308-379-8637
Mailing Address - Fax:
Practice Address - Street 1:4234 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:GRANDI ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803
Practice Address - Country:US
Practice Address - Phone:308-379-8637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2112124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist