MEDICARE: LINDSTEN FAMILY DENTISTRY

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

General Provider Information

NPI Number	:	1104109941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINDSTEN FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	1437 S BELL SCHOOL RD
Second Line	:	#2
City	:	ROCKFORD
State	:	IL
Zip	:	61108-1405
Country	:	US
Telephone Number	:	815-398-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1437 S BELL SCHOOL RD
Second Line	:	#2
City	:	ROCKFORD
State	:	IL
Zip	:	61108-1405
Country	:	US
Telephone Number	:	815-398-3900
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MATTHEW P LINDSTEN
Credential	:	DDS
Telephone Number	:	815-398-3900

Provider Enumeration Date	:	09/27/2011
Last Update Date	:	09/27/2011

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Directions to “LINDSTEN FAMILY DENTISTRY ” Practice Location

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