Provider Demographics
NPI:1053405472
Name:HENELL, LINDI (DDS)
Entity type:Individual
Prefix:DR
First Name:LINDI
Middle Name:
Last Name:HENELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W EL CAMINO REAL STE 74A
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2649
Mailing Address - Country:US
Mailing Address - Phone:408-739-4560
Mailing Address - Fax:
Practice Address - Street 1:100 W EL CAMINO REAL STE 74A
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2649
Practice Address - Country:US
Practice Address - Phone:408-739-4560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39809122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist