MEDICARE: LINDSAY AND MAGRUDER ORTHODONTICS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1215453212	OTHER	TX	NPPES
2	1003916503	OTHER	TX	NPPES

General Provider Information

NPI Number	:	1134693963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINDSAY AND MAGRUDER ORTHODONTICS

Provider Business Mailing Address
First Line	:	1616 CLEAR LAKE CITY BLVD STE 108
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77062-8069
Country	:	US
Telephone Number	:	281-486-1018
Fax Number	:	281-486-1075

Provider Business Practice Location Address
First Line	:	1616 CLEAR LAKE CITY BLVD STE 108
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77062-8069
Country	:	US
Telephone Number	:	281-486-1018
Fax Number	:	281-486-1075

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SONIA H MAGRUDER
Credential	:	DDS
Telephone Number	:	281-486-1018

Provider Enumeration Date	:	01/15/2019
Last Update Date	:	01/15/2019

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