MEDICARE: DR. LYNDON BRUCE BROWN D.D.S.

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	1223P0700X	Prosthodontics	40058	CA

General Provider Information

NPI Number	:	1972509354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNDON BRUCE BROWN D.D.S.

Provider Business Mailing Address
First Line	:	2022 BRUCEALA CT
Second Line	:
City	:	CARDIFF BY THE SEA
State	:	CA
Zip	:	92007-1201
Country	:	US
Telephone Number	:	760-499-1246
Fax Number	:

Provider Business Practice Location Address
First Line	:	2022 BRUCEALA CT
Second Line	:
City	:	CARDIFF BY THE SEA
State	:	CA
Zip	:	92007-1201
Country	:	US
Telephone Number	:	760-499-1246
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2007

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