Provider Demographics
NPI:1174776967
Name:MAPLES, LINDSAY GREMILLION (DMD)
Entity type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:GREMILLION
Last Name:MAPLES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:GAYLE
Other - Last Name:GREMILLION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:926 GREAT POND DR
Mailing Address - Street 2:SUITE 2003
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:407-788-3572
Practice Address - Street 1:1023 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:FL
Practice Address - Zip Code:32233-3313
Practice Address - Country:US
Practice Address - Phone:904-249-3104
Practice Address - Fax:904-249-3109
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18271122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist