MEDICARE: DR. BETSY MATSUNO-LINDBERGH 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	44073	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	266897	OTHER	CA	UNITED CONCORDIA PROVIDER

General Provider Information

NPI Number	:	1770791535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETSY MATSUNO-LINDBERGH DDS

Provider Business Mailing Address
First Line	:	2468 STAPLETON AVE
Second Line	:
City	:	IMPERIAL
State	:	CA
Zip	:	92251-9018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 N IMPERIAL AVE
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-2338
Country	:	US
Telephone Number	:	760-353-3720
Fax Number	:

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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