MEDICARE: DR. LYNNE S SPENCER GERLACH 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	15499	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	752403988	OTHER	TX	TAXID

General Provider Information

NPI Number	:	1285761551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNNE S SPENCER GERLACH DDS

Provider Business Mailing Address
First Line	:	5800 COIT RD
Second Line	:	SUITE 800
City	:	PLANO
State	:	TX
Zip	:	75023-5942
Country	:	US
Telephone Number	:	972-964-1855
Fax Number	:	972-867-2403

Provider Business Practice Location Address
First Line	:	5800 COIT RD
Second Line	:	SUITE 800
City	:	PLANO
State	:	TX
Zip	:	75023-5942
Country	:	US
Telephone Number	:	972-964-1855
Fax Number	:	972-867-2403

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	10/30/2009

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