MEDICARE: LYNN LINVILLE-LAURITANO III 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	5030	NC

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	:	1194763854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN LINVILLE-LAURITANO III DDS

Provider Business Mailing Address
First Line	:	2605 BLUE RIDGE RD
Second Line	:	STE 200
City	:	RALEIGH
State	:	NC
Zip	:	27607-6475
Country	:	US
Telephone Number	:	919-781-8920
Fax Number	:	919-571-9543

Provider Business Practice Location Address
First Line	:	2605 BLUE RIDGE RD
Second Line	:	STE 200
City	:	RALEIGH
State	:	NC
Zip	:	27607-6475
Country	:	US
Telephone Number	:	919-781-8920
Fax Number	:	919-571-9543

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	07/08/2007

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