MEDICARE: MR. STEPHEN CHARLES LINDBLOM 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	48949	CA

General Provider Information

NPI Number	:	1851308688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN CHARLES LINDBLOM DDS

Provider Business Mailing Address
First Line	:	3221 JEFFERSON AVE
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94062
Country	:	US
Telephone Number	:	650-365-2683
Fax Number	:	650-365-2684

Provider Business Practice Location Address
First Line	:	3221 JEFFERSON AVE
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94062
Country	:	US
Telephone Number	:	650-365-2683
Fax Number	:	650-365-2684

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	04/14/2010

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