MEDICARE: LAWRENCE P PENDLETON 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	1223G0001X	General Practice Dentistry	1400	MT

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	:	1982753398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE P PENDLETON DMD

Provider Business Mailing Address
First Line	:	108 NORTH 11TH AVENUE
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59715-3262
Country	:	US
Telephone Number	:	406-586-5949
Fax Number	:	406-586-3703

Provider Business Practice Location Address
First Line	:	108 NORTH 11TH AVENUE
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59715-3262
Country	:	US
Telephone Number	:	406-586-5949
Fax Number	:	406-586-3703

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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