=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053821975
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDSAY RAMBO D.M.D., M.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2017
-----------------------------------------------------
Last Update Date | 10/05/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2120 N BROAD ST
-----------------------------------------------------
City | LANSDALE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19446-1055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-362-2810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 DETWEILER RD
-----------------------------------------------------
City | SELLERSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18960-1611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DS040594
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------