MEDICARE: DR. ADRIAN LOBONO DDS

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	19026777	IL
2	1223P0700X	Prosthodontics	019026777	IL

General Provider Information

NPI Number	:	1588634281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADRIAN LOBONO DDS

Provider Business Mailing Address
First Line	:	BLDG 6-6837 NORMANDY DRIVE
Second Line	:	USA DENTAC
City	:	FT BRAGG
State	:	NC
Zip	:	28310-7302
Country	:	US
Telephone Number	:	910-643-2196
Fax Number	:	910-643-7017

Provider Business Practice Location Address
First Line	:	BLDG 6-6837 NORMANDY DRIVE
Second Line	:	USA DENTAC
City	:	FT BRAGG
State	:	NC
Zip	:	28310-7302
Country	:	US
Telephone Number	:	910-643-2196
Fax Number	:	910-643-7017

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	07/19/2011

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