MEDICARE: BEAVERCREEK ENDODONTICS- EMILY LAMMERS DDS MS INC.

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	1223E0200X	Endodontics	30.023278	OH

General Provider Information

NPI Number	:	1215314240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAVERCREEK ENDODONTICS- EMILY LAMMERS DDS MS INC.

Provider Business Mailing Address
First Line	:	1555 MARSETTA DR
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2732
Country	:	US
Telephone Number	:	937-426-7611
Fax Number	:	937-426-4331

Provider Business Practice Location Address
First Line	:	1555 MARSETTA DR
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2732
Country	:	US
Telephone Number	:	937-426-7611
Fax Number	:	937-426-4331

Authorized Official
Title or Position	:	OWNER, ENDODONTIST
Name	:	DR. EMILY LAMMERS
Credential	:	DDS, MS
Telephone Number	:	614-565-6556

Provider Enumeration Date	:	04/28/2015
Last Update Date	:	04/28/2015

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