Provider Demographics
NPI:1255597480
Name:DR. JONATHAN LINDSEY DDS, PA
Entity type:Organization
Organization Name:DR. JONATHAN LINDSEY DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-733-2042
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:NEWLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28657
Mailing Address - Country:US
Mailing Address - Phone:828-733-2042
Mailing Address - Fax:828-733-2155
Practice Address - Street 1:1632 MILLERS GAP HWY
Practice Address - Street 2:
Practice Address - City:NEWLAND
Practice Address - State:NC
Practice Address - Zip Code:28657
Practice Address - Country:US
Practice Address - Phone:828-733-2042
Practice Address - Fax:828-733-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8995296Medicaid
NC95296OtherBLUE CROSS BLUE SHIELD