MEDICARE: LINDA LEWIS 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	MN11237	MN

General Provider Information

NPI Number	:	1003965195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA LEWIS DDS

Provider Business Mailing Address
First Line	:	35252 COUNTY ROAD 3
Second Line	:	P.O. BOX 548
City	:	CROSSLAKE
State	:	MN
Zip	:	56442-2804
Country	:	US
Telephone Number	:	218-692-1522
Fax Number	:	218-692-1524

Provider Business Practice Location Address
First Line	:	35252 COUNTY ROAD 3
Second Line	:
City	:	CROSSLAKE
State	:	MN
Zip	:	56442-2804
Country	:	US
Telephone Number	:	218-692-1522
Fax Number	:	218-692-1524

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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