Provider Demographics
NPI:1366422818
Name:LINDGREN, JEREMIAH MAURICE (DDS)
Entity type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:MAURICE
Last Name:LINDGREN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 S 2300 W
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-5002
Mailing Address - Country:US
Mailing Address - Phone:801-643-6541
Mailing Address - Fax:
Practice Address - Street 1:1064 S 2300 W
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-5002
Practice Address - Country:US
Practice Address - Phone:801-643-6167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT28365799221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice