MEDICARE: DR. ZACHARY THEODORE LINDQUIST I 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	122300000X	Dentist	203314	CO

General Provider Information

NPI Number	:	1801310479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZACHARY THEODORE LINDQUIST I DDS

Provider Business Mailing Address
First Line	:	404 N FEDERAL AVE
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-3293
Country	:	US
Telephone Number	:	641-450-0601
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 N FEDERAL AVE
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-3293
Country	:	US
Telephone Number	:	641-450-0601
Fax Number	:

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

Provider Enumeration Date	:	07/26/2017
Last Update Date	:	11/01/2022

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