MEDICARE: LAKEVIEW ORTHODONTICS 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	:	1316560592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEVIEW ORTHODONTICS PLLC

Provider Business Mailing Address
First Line	:	8140 ARLINGTON AVE
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-2711
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	959 S TOWNSHIP LINE RD STE G
Second Line	:
City	:	ROYERSFORD
State	:	PA
Zip	:	19468-1823
Country	:	US
Telephone Number	:	215-964-7920
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. HAMID HASHEMI
Credential	:	DMD, MS, MBA
Telephone Number	:	215-964-7920

Provider Enumeration Date	:	05/22/2020
Last Update Date	:	05/22/2020

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