MEDICARE: DR. EVAN HOWARD LEDIS 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	12341	FL

General Provider Information

NPI Number	:	1295801652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVAN HOWARD LEDIS DDS

Provider Business Mailing Address
First Line	:	6910 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2903
Country	:	US
Telephone Number	:	561-967-7400
Fax Number	:	561-967-7491

Provider Business Practice Location Address
First Line	:	6910 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2903
Country	:	US
Telephone Number	:	561-967-7400
Fax Number	:	561-967-7491

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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