MEDICARE: LINCOLN DENTAL FAMILY CENTER

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

General Provider Information

NPI Number	:	1881861607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINCOLN DENTAL FAMILY CENTER

Provider Business Mailing Address
First Line	:	5643 N FAIRFIELD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659
Country	:	US
Telephone Number	:	773-271-5200
Fax Number	:	773-271-3280

Provider Business Practice Location Address
First Line	:	5643 N FAIRFIELD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659
Country	:	US
Telephone Number	:	773-271-5200
Fax Number	:	773-271-3280

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. MARY M HANLEY
Credential	:	DDS
Telephone Number	:	773-271-5200

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	05/12/2008

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