MEDICARE: DR. STEPHEN RAY LINCOLN 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	D1359	ID

General Provider Information

NPI Number	:	1841307048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN RAY LINCOLN DDS

Provider Business Mailing Address
First Line	:	174 ASH STREET NORTH
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-5232
Country	:	US
Telephone Number	:	208-734-3148
Fax Number	:	208-736-3907

Provider Business Practice Location Address
First Line	:	174 ASH STREET NORTH
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-5232
Country	:	US
Telephone Number	:	208-734-3148
Fax Number	:	208-736-3907

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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