MEDICARE: LINDA TIFFINMASCORRO D.D.S.

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	1917727	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144374034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA TIFFINMASCORRO D.D.S.

Provider Business Mailing Address
First Line	:	3008 MAPLE AVE
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-2849
Country	:	US
Telephone Number	:	708-484-2175
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 W TAYLOR ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-4236
Country	:	US
Telephone Number	:	312-421-4646
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/09/2007

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