MEDICARE: DRS. LINEBERGER BANSCH AND REIMELS PLLC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1316412430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS. LINEBERGER BANSCH AND REIMELS PLLC

Provider Business Mailing Address
First Line	:	9625 NORTHCROSS CENTER CT STE 303
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-7353
Country	:	US
Telephone Number	:	704-736-1765
Fax Number	:

Provider Business Practice Location Address
First Line	:	2734 ROZZELLES FERRY RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-3233
Country	:	US
Telephone Number	:	704-927-5499
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	CANDIE GOODWIN
Credential	:
Telephone Number	:	704-892-6160

Provider Enumeration Date	:	10/04/2018
Last Update Date	:	10/04/2018

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