MEDICARE: ROBERT LONNIE LAING 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	10839	MN

General Provider Information

NPI Number	:	1841351582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT LONNIE LAING DDS

Provider Business Mailing Address
First Line	:	1099 EAST MOORE LAKE DRIVE
Second Line	:
City	:	FRIDLEY
State	:	MN
Zip	:	55432
Country	:	US
Telephone Number	:	763-586-9988
Fax Number	:	763-586-9977

Provider Business Practice Location Address
First Line	:	1099 EAST MOORE LAKE DRIVE
Second Line	:
City	:	FRIDLEY
State	:	MN
Zip	:	55432
Country	:	US
Telephone Number	:	763-586-9988
Fax Number	:	763-586-9977

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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