Provider Demographics
NPI:1861754418
Name:LINDQUIST, MOLLIE KARLEEN (DDS)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:KARLEEN
Last Name:LINDQUIST
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:994 DIAMOND RDG
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6885
Mailing Address - Country:US
Mailing Address - Phone:573-635-3576
Mailing Address - Fax:
Practice Address - Street 1:994 DIAMOND RDG
Practice Address - Street 2:SUITE 200
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6885
Practice Address - Country:US
Practice Address - Phone:573-635-3576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012017879122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist