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NPI Code Detail

MEDICARE: DR. LINDSAY S. TAKEDA DDS

MEDICARE: DR. LINDSAY S. TAKEDA 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
11223G0001XGeneral Practice Dentistry29674CA

General Provider Information

NPI Number : 1558408658
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LINDSAY S. TAKEDA DDS
Provider Business Mailing Address
First Line : 1394 E ALLUVIAL AVE
Second Line : STE 104
City : FRESNO
State : CA
Zip : 93720-2608
Country : US
Telephone Number : 559-226-7464
Fax Number : 559-226-5309
Provider Business Practice Location Address
First Line : 1394 E ALLUVIAL AVE
Second Line : STE 104
City : FRESNO
State : CA
Zip : 93720-2608
Country : US
Telephone Number : 559-226-7464
Fax Number : 559-226-5309
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 07/08/2007

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