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General NPI Number Information
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NPI Number | 1326011065
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Entity Type | Individual
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Provider Name | JOHN ROBERT LUNDSTROM D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 10/02/2009
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Provider Practice Location Address
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Address Line | 57337 YUCCA TRL
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-3851
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Country | US
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Telephone | 760-365-7691
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Fax |
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Provider Business Mailing Address
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Address Line | 57945 CARLYLE DR
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-6210
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Country | US
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Telephone | 319-594-6132
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 58731
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 7627
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License Number State | NC
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