MEDICARE: LINDA RASKANSKY 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	122300000X	Dentist	D6384	AZ

General Provider Information

NPI Number	:	1578682829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA RASKANSKY D.M.D,

Provider Business Mailing Address
First Line	:	8279 W LAKE PLEASANT PKWY STE 110
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-7434
Country	:	US
Telephone Number	:	623-878-0120
Fax Number	:	623-825-6820

Provider Business Practice Location Address
First Line	:	8279 W LAKE PLEASANT PKWY STE 110
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-7434
Country	:	US
Telephone Number	:	623-878-0120
Fax Number	:	623-825-6820

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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