MEDICARE: DR. LINDSAY LELAND DMD

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	DN013333	GA
2	122300000X	Dentist	56897	CA

General Provider Information

NPI Number	:	1639223092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDSAY LELAND DMD

Provider Business Mailing Address
First Line	:	3960 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3502
Country	:	US
Telephone Number	:	562-988-0148
Fax Number	:	678-990-0359

Provider Business Practice Location Address
First Line	:	3960 ATLANTIC AVE STE 105-B
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3502
Country	:	US
Telephone Number	:	562-988-0148
Fax Number	:	678-990-0359

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	11/18/2021

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