MEDICARE: ACCESS ORTHODONTICS OF LAKE JUNE PA

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1053640680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS ORTHODONTICS OF LAKE JUNE PA

Provider Business Mailing Address
First Line	:	6909 LAKE JUNE RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-1325
Country	:	US
Telephone Number	:	214-391-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	6909 LAKE JUNE RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-1325
Country	:	US
Telephone Number	:	214-391-1900
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANURAG PATEL
Credential	:	DMD
Telephone Number	:	214-391-1900

Provider Enumeration Date	:	12/10/2009
Last Update Date	:	12/10/2009

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