Provider Demographics
NPI:1487781811
Name:EASTMAN, LINDSAY BETHEL (DDS MS PA)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:BETHEL
Last Name:EASTMAN
Suffix:
Gender:M
Credentials:DDS MS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 G 59TH ST WEST
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209
Mailing Address - Country:US
Mailing Address - Phone:941-792-3899
Mailing Address - Fax:941-792-3778
Practice Address - Street 1:1906 G 59TH ST WEST
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209
Practice Address - Country:US
Practice Address - Phone:941-792-3899
Practice Address - Fax:941-792-3778
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00080881223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
421692OtherUNITED CONCORDIA