MEDICARE: LYNDON MACKAY

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	122300000X	Dentist	134443	UT

General Provider Information

NPI Number	:	1093910267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDON MACKAY

Provider Business Mailing Address
First Line	:	31 LAKE RIDGE DR
Second Line	:
City	:	KAYSVILLE
State	:	UT
Zip	:	84037-9655
Country	:	US
Telephone Number	:	801-451-5073
Fax Number	:

Provider Business Practice Location Address
First Line	:	3550 S 4800 W STE J
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-2959
Country	:	US
Telephone Number	:	801-969-3025
Fax Number	:

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

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/08/2007

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Directions to “ LYNDON MACKAY ” Practice Location

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