Provider Demographics
NPI:1598047003
Name:LINDELL, JOHN M (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:LINDELL
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1738
Mailing Address - Country:US
Mailing Address - Phone:775-336-9198
Mailing Address - Fax:
Practice Address - Street 1:5021 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-4292
Practice Address - Country:US
Practice Address - Phone:262-632-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190288401223G0001X
WI6000050151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral Practice