MEDICARE: DR. ALEXANDERIA LYNNE BERTRAND 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	122300000X	Dentist	DN29058	FL

General Provider Information

NPI Number	:	1689416646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDERIA LYNNE BERTRAND DMD

Provider Business Mailing Address
First Line	:	7712 MCELVEY RD
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32408-4934
Country	:	US
Telephone Number	:	906-236-4579
Fax Number	:

Provider Business Practice Location Address
First Line	:	17350 PANAMA CITY BEACH PKWY
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32413-6039
Country	:	US
Telephone Number	:	850-230-3364
Fax Number	:

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

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	06/11/2024

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