Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 12012364A | IN |
N | 1223X0400X | Orthodontists | 30.025217 | OH |
NPI | 1063896041 |
---|---|
Provider Name | Lindsay Desantis |
First Address | Williamsburg, IN 47393-9794 |
Second Address | Greenville, OH 45331-2529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2015 |
Last Update Date | 21/09/2021 |