MEDICARE: DR. CHRISTINA WYCKOFF LEDBETTER D.M.D.

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	019-026199	IL
2	1223G0001X	General Practice Dentistry	9122	TN

General Provider Information

NPI Number	:	1477541464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA WYCKOFF LEDBETTER D.M.D.

Provider Business Mailing Address
First Line	:	2812 OLD FORT PKWY
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37128-4265
Country	:	US
Telephone Number	:	615-896-9322
Fax Number	:	615-896-2122

Provider Business Practice Location Address
First Line	:	2812 OLD FORT PKWY
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37128-4265
Country	:	US
Telephone Number	:	615-896-9322
Fax Number	:	615-896-2122

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	10/19/2011

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