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General NPI Number Information
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NPI Number | 1487025391
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Entity Type | Organization
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Legal Business Name | DUBUQUE ENDODONTICS, PC
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 988 W 3RD ST SUITE 107
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City | DUBUQUE
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State | IA
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Zip | 52001-6666
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Country | US
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Telephone | 563-583-1050
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Fax |
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Provider Business Mailing Address
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Address Line | 988 W 3RD ST SUITE 107
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City | DUBUQUE
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State | IA
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Zip | 52001-6666
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Country | US
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Telephone | 563-583-1050
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Fax |
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | DR. JOHN ROBERT LUNDSTROM I
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Credential | D.D.S., M.S.
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Telephone | 563-583-1050
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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 | DDS-08953
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License Number State | IA
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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 | DDS-09070
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License Number State | IA
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