MEDICARE: LYNN E GASSOWAY 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	1223G0001X	General Practice Dentistry	12007149	IN

General Provider Information

NPI Number	:	1962500298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN E GASSOWAY DDS

Provider Business Mailing Address
First Line	:	8412 MAPLE AVE
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46403
Country	:	US
Telephone Number	:	219-938-2875
Fax Number	:	216-938-2875

Provider Business Practice Location Address
First Line	:	8412 MAPLE AVE
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46403
Country	:	US
Telephone Number	:	219-938-2875
Fax Number	:	216-938-2875

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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Directions to “ LYNN E GASSOWAY DDS” Practice Location

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