MEDICARE: LUNDEEN DENTAL CARE PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1134940018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUNDEEN DENTAL CARE PLLC

Provider Business Mailing Address
First Line	:	3221 S CARRIER PKWY
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-6052
Country	:	US
Telephone Number	:	972-262-5181
Fax Number	:

Provider Business Practice Location Address
First Line	:	3221 S CARRIER PKWY
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-6052
Country	:	US
Telephone Number	:	972-262-5181
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CALEB LUNDEEN
Credential	:	DDS
Telephone Number	:	210-630-5598

Provider Enumeration Date	:	10/22/2024
Last Update Date	:	10/22/2024

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