MEDICARE: LISA B VALINS 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	044600-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952401788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA B VALINS DMD

Provider Business Mailing Address
First Line	:	213-05 UNION TURNPIKE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11364-3593
Country	:	US
Telephone Number	:	718-464-0768
Fax Number	:	718-217-5240

Provider Business Practice Location Address
First Line	:	213-05 UNION TURNPIKE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11364-3593
Country	:	US
Telephone Number	:	718-464-0768
Fax Number	:	718-217-5240

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/08/2007

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