MEDICARE: MCDUFFEE LIMA DENTISTRY LLC

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	261QD0000X	Dental Clinic/Center	17811	OH

General Provider Information

NPI Number	:	1548755333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCDUFFEE LIMA DENTISTRY LLC

Provider Business Mailing Address
First Line	:	3927 COLUMBUS RD
Second Line	:
City	:	CENTERBURG
State	:	OH
Zip	:	43011-9475
Country	:	US
Telephone Number	:	740-480-8162
Fax Number	:	740-480-8179

Provider Business Practice Location Address
First Line	:	3927 COLUMBUS RD
Second Line	:
City	:	CENTERBURG
State	:	OH
Zip	:	43011-9475
Country	:	US
Telephone Number	:	740-480-8162
Fax Number	:	740-480-8179

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MALINDA SHIPMAN
Credential	:
Telephone Number	:	740-480-8162

Provider Enumeration Date	:	06/25/2018
Last Update Date	:	06/25/2018

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