MEDICARE: DR. SYDNEY LUNDY 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	122300000X	Dentist	26128	FL
2	122300000X	Dentist	11672	TN

General Provider Information

NPI Number	:	1184297095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SYDNEY LUNDY DMD

Provider Business Mailing Address
First Line	:	20009 HOLLY LAKE PL
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558-5030
Country	:	US
Telephone Number	:	813-362-3086
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 HARBOR VILLAGE LN
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-3426
Country	:	US
Telephone Number	:	813-544-7003
Fax Number	:

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

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	09/27/2021

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