Provider Demographics
NPI:1053976316
Name:THORN, LINDSAY A (MS, DMD)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:A
Last Name:THORN
Suffix:
Gender:F
Credentials:MS, DMD
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:A
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1113 PIEDMONT ST SE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1223
Mailing Address - Country:US
Mailing Address - Phone:540-904-4020
Mailing Address - Fax:
Practice Address - Street 1:1113 PIEDMONT ST SE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1223
Practice Address - Country:US
Practice Address - Phone:540-904-4020
Practice Address - Fax:540-903-4030
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014165941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice