MEDICARE: DR. ANTHONY LINDAHL DMD

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	122300000X	Dentist	2003017402	MO

General Provider Information

NPI Number	:	1417098765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY LINDAHL DMD

Provider Business Mailing Address
First Line	:	1338 SUNBURST DR
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-3491
Country	:	US
Telephone Number	:	636-272-3503
Fax Number	:	636-272-3504

Provider Business Practice Location Address
First Line	:	1338 SUNBURST DR
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-3491
Country	:	US
Telephone Number	:	636-272-3503
Fax Number	:	636-272-3504

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

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