MEDICARE: DR. LINDSEY DEY ANZALONE 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	122300000X	Dentist	DD3134	NM
2	122300000X	Dentist	7029	NE
3	122300000X	Dentist	08968	IA

General Provider Information

NPI Number	:	1679701387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDSEY DEY ANZALONE DDS

Provider Business Mailing Address
First Line	:	2114 PIERCE ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-3847
Country	:	US
Telephone Number	:	712-252-3440
Fax Number	:

Provider Business Practice Location Address
First Line	:	2114 PIERCE ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-3847
Country	:	US
Telephone Number	:	712-252-3440
Fax Number	:

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

Provider Enumeration Date	:	07/01/2009
Last Update Date	:	09/24/2012

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