MEDICARE: BEVERLY HILLS PEDIATRIC DENTAL CARE, INC

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	41023	CA

General Provider Information

NPI Number	:	1164715868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLY HILLS PEDIATRIC DENTAL CARE, INC

Provider Business Mailing Address
First Line	:	8920 WILSHIRE BLVD
Second Line	:	SUITE 427
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2007
Country	:	US
Telephone Number	:	310-657-6434
Fax Number	:	310-657-6310

Provider Business Practice Location Address
First Line	:	8920 WILSHIRE BOULEVARD
Second Line	:	SUITE 427
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2004
Country	:	US
Telephone Number	:	310-657-6434
Fax Number	:	310-657-6310

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LYNN SARAH LEMPERT
Credential	:	DDS
Telephone Number	:	310-850-6667

Provider Enumeration Date	:	05/27/2011
Last Update Date	:	05/27/2011

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