MEDICARE: DR. BONNIE LEDERMAN 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	1223G0001X	General Practice Dentistry	2095	MT

General Provider Information

NPI Number	:	1295900678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BONNIE LEDERMAN D.D.S.

Provider Business Mailing Address
First Line	:	2515 6TH AVE S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-3013
Country	:	US
Telephone Number	:	406-761-1945
Fax Number	:

Provider Business Practice Location Address
First Line	:	2515 6TH AVE S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-3013
Country	:	US
Telephone Number	:	406-761-1945
Fax Number	:

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

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	12/08/2010

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