Provider Demographics
NPI:1861757940
Name:PEDERSEN, LINDSEY JEAN (DMD)
Entity type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:JEAN
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 E WEST HWY
Mailing Address - Street 2:SUITE 15
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2060
Mailing Address - Country:US
Mailing Address - Phone:240-696-1323
Mailing Address - Fax:
Practice Address - Street 1:3601 E WEST HWY
Practice Address - Street 2:SUITE 15
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2060
Practice Address - Country:US
Practice Address - Phone:240-696-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014136691223G0001X
MD151281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice