MEDICARE: DR. LINDA MALMSTROM FORTENBERRY DMD

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	015106	MA

General Provider Information

NPI Number	:	1841373560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA MALMSTROM FORTENBERRY DMD

Provider Business Mailing Address
First Line	:	PO BOX 1459
Second Line	:
City	:	EAST DENNIS
State	:	MA
Zip	:	02641-1459
Country	:	US
Telephone Number	:	508-385-3004
Fax Number	:	508-385-2412

Provider Business Practice Location Address
First Line	:	1335 ROUTE 134
Second Line	:
City	:	EAST DENNIS
State	:	MA
Zip	:	02641
Country	:	US
Telephone Number	:	508-385-3004
Fax Number	:	508-385-2412

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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