Healthcare Provider Details

I. General information

NPI: 1285067249
Provider Name (Legal Business Name): BRITTA LEE LUNDGREN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 MILITARY CUTOFF RD STE 105
WILMINGTON NC
28403-3692
US

IV. Provider business mailing address

1427 MILITARY CUTOFF RD STE 105
WILMINGTON NC
28403-3692
US

V. Phone/Fax

Practice location:
  • Phone: 910-233-4236
  • Fax:
Mailing address:
  • Phone: 910-233-4236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8273
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10585
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: