MEDICARE: LYNN AKWEN SITHO ANDOSEH 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	122300000X	Dentist	15095	MD
2	390200000X	Student in an Organized Health Care Education/Training Program
3	122300000X	Dentist	DEN1001371	DC

General Provider Information

NPI Number	:	1184862369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN AKWEN SITHO ANDOSEH D.D.S.

Provider Business Mailing Address
First Line	:	10205 JUNIPER DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-2721
Country	:	US
Telephone Number	:	240-281-1983
Fax Number	:

Provider Business Practice Location Address
First Line	:	1531 MARYLAND AVE NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-7604
Country	:	US
Telephone Number	:	202-470-5873
Fax Number	:

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

Provider Enumeration Date	:	01/27/2009
Last Update Date	:	09/24/2014

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