MEDICARE: DR. LISA ALLYN SLINGBAUM D.M.D.

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	16854	FL

General Provider Information

NPI Number	:	1144429242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA ALLYN SLINGBAUM D.M.D.

Provider Business Mailing Address
First Line	:	3716 N ROOSEVELT BLVD
Second Line	:	SUITE 6
City	:	KEY WEST
State	:	FL
Zip	:	33040-4533
Country	:	US
Telephone Number	:	305-296-8665
Fax Number	:	305-294-0055

Provider Business Practice Location Address
First Line	:	3716 N ROOSEVELT BLVD
Second Line	:	SUITE 6
City	:	KEY WEST
State	:	FL
Zip	:	33040-4533
Country	:	US
Telephone Number	:	305-296-8665
Fax Number	:	305-294-0055

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

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	07/17/2007

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