MEDICARE: DR. KENNETH J. LINCK DDS

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	1223G0001X	General Practice Dentistry	11115	MO

General Provider Information

NPI Number	:	1356374474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH J. LINCK DDS

Provider Business Mailing Address
First Line	:	9 CARRICO OAKS CT
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63034-1127
Country	:	US
Telephone Number	:	314-921-3970
Fax Number	:

Provider Business Practice Location Address
First Line	:	4161 N US HIGHWAY 67
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63034-2825
Country	:	US
Telephone Number	:	314-653-6700
Fax Number	:	314-653-6500

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/08/2007

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