MEDICARE: DR. WENDY L. SYDLEWSKI DDS, MD.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	10622	MN

General Provider Information

NPI Number	:	1174677710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WENDY L. SYDLEWSKI DDS, MD.

Provider Business Mailing Address
First Line	:	2126 5TH ST
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-2717
Country	:	US
Telephone Number	:	651-426-9986
Fax Number	:

Provider Business Practice Location Address
First Line	:	2126 5TH ST
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-2717
Country	:	US
Telephone Number	:	651-426-9986
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	05/14/2008

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