MEDICARE: LINDSAY BALFOUR DMD

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	1223G0001X	General Practice Dentistry	DE61083040	WA

General Provider Information

NPI Number	:	1073121216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY BALFOUR DMD

Provider Business Mailing Address
First Line	:	BOX 388
Second Line	:
City	:	PINCHER CREEK
State	:	ALBERTA
Zip	:	T0K1W0
Country	:	CA
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	708 E MOUNTAIN VIEW AVE
Second Line	:
City	:	ELLENSBURG
State	:	WA
Zip	:	98926-3862
Country	:	US
Telephone Number	:	509-962-2755
Fax Number	:

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

Provider Enumeration Date	:	07/14/2020
Last Update Date	:	07/14/2020

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