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NPI Code Detail

MEDICARE: DR. LYNDA M. MACKUS D.D.S.

MEDICARE: DR. LYNDA M. MACKUS D.D.S.
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
11223G0001XGeneral Practice Dentistry012172MI

General Provider Information

NPI Number : 1619019817
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LYNDA M. MACKUS D.D.S.
Provider Business Mailing Address
First Line : 3168 PORT SHELDON ST
Second Line :
City : HUDSONVILLE
State : MI
Zip : 49426-9317
Country : US
Telephone Number : 616-669-2040
Fax Number : 616-669-3147
Provider Business Practice Location Address
First Line : 3168 PORT SHELDON ST
Second Line :
City : HUDSONVILLE
State : MI
Zip : 49426-9317
Country : US
Telephone Number : 616-669-2040
Fax Number : 616-669-3147
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2007
Last Update Date : 07/08/2007

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