MEDICARE: DR. SCOTT W POWERS DDS

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	12010062	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	352116058001	OTHER	IN	ANTHEM FEDERAL EMPLOYEE

General Provider Information

NPI Number	:	1154367449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT W POWERS DDS

Provider Business Mailing Address
First Line	:	PO BOX 236
Second Line	:
City	:	LYONS
State	:	IN
Zip	:	47443-0236
Country	:	US
Telephone Number	:	812-659-3901
Fax Number	:	812-659-3903

Provider Business Practice Location Address
First Line	:	195 E BROAD ST
Second Line	:
City	:	LYONS
State	:	IN
Zip	:	47443-0236
Country	:	US
Telephone Number	:	812-659-3901
Fax Number	:	812-659-3903

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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