MEDICARE: LEHMAN DRIVE PDC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223E0200X	Endodontics
2	1223P0300X	Periodontics
3	122300000X	Dentist

General Provider Information

NPI Number	:	1942867650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEHMAN DRIVE PDC PLLC

Provider Business Mailing Address
First Line	:	PO BOX 970385
Second Line	:
City	:	OREM
State	:	UT
Zip	:	84097-0309
Country	:	US
Telephone Number	:	801-305-3460
Fax Number	:	801-335-6551

Provider Business Practice Location Address
First Line	:	5925 LEHMAN DR STE 2
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3418
Country	:	US
Telephone Number	:	719-598-6966
Fax Number	:	844-335-8493

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	JACOB WARNER
Credential	:
Telephone Number	:	801-691-1701

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	05/29/2019

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