MEDICARE: DR. ELIZABETH LING 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	14419	TX

General Provider Information

NPI Number	:	1104043785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH LING DMD

Provider Business Mailing Address
First Line	:	4012 MARATHON BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3718
Country	:	US
Telephone Number	:	512-454-7641
Fax Number	:	512-371-7161

Provider Business Practice Location Address
First Line	:	4012 MARATHON BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3718
Country	:	US
Telephone Number	:	512-454-7641
Fax Number	:	512-371-7161

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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