MEDICARE: DR. LISBETH W POAG DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	3503-0509PD	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013960616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISBETH W POAG DMD

Provider Business Mailing Address
First Line	:	500 PHYSICIANS LN
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-3370
Country	:	US
Telephone Number	:	803-775-4793
Fax Number	:	803-934-9943

Provider Business Practice Location Address
First Line	:	500 PHYSICIANS LN
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-3370
Country	:	US
Telephone Number	:	803-775-4793
Fax Number	:	803-934-9943

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/09/2012

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