Provider Demographics
NPI:1831573625
Name:HALL, LINDSAY MOBLEY (DMD)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MOBLEY
Last Name:HALL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:ELIZABETH
Other - Last Name:MOBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:4612 HOLLY BERRY DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3800 N MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6414
Practice Address - Country:US
Practice Address - Phone:803-705-3169
Practice Address - Fax:803-705-3170
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.8606 GD122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX8606Medicaid