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General NPI Number Information
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NPI Number | 1588052377
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Entity Type | Individual
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Provider Name | JODY MILBERT LUNDELL GDH
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Gender | Female
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Dates
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Enumeration Date | 12/31/2014
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Last Update Date | 12/31/2014
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Provider Practice Location Address
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Address Line | 3664 MOUNT VERNON LN
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City | WOODBURY
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State | MN
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Zip | 55129-9382
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Country | US
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Telephone | 414-303-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 3664 MOUNT VERNON LN
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City | WOODBURY
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State | MN
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Zip | 55129-9382
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Country | US
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Telephone | 414-303-2550
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 5739-16
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H2738
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License Number State | MN
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