MEDICARE: LYNN R,, CHENEY, DDS, PLLC

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	DE00008524	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730148248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNN R,, CHENEY, DDS, PLLC

Provider Business Mailing Address
First Line	:	1221 W MAIN ST
Second Line	:
City	:	MONROE
State	:	WA
Zip	:	98272-2028
Country	:	US
Telephone Number	:	360-794-5788
Fax Number	:	360-863-0318

Provider Business Practice Location Address
First Line	:	1221 W MAIN ST
Second Line	:
City	:	MONROE
State	:	WA
Zip	:	98272-2028
Country	:	US
Telephone Number	:	360-794-5788
Fax Number	:	360-863-0318

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LYNN R CHENEY
Credential	:	DDS
Telephone Number	:	360-794-5788

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	10/03/2012

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