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General NPI Number Information
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NPI Number | 1700402435
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Entity Type | Individual
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Provider Name | TRISTAN LUNSFORD DDS
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Gender | Male
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Dates
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Enumeration Date | 06/18/2020
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 227 W MONROE ST STE 205
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City | CHICAGO
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State | IL
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Zip | 60606-5017
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Country | US
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Telephone | 312-346-0171
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Fax |
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Provider Business Mailing Address
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Address Line | 3389 TIMBERLAKE DR
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City | WALLED LAKE
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State | MI
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Zip | 48390-1271
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Country | US
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Telephone | 248-787-6948
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.032696
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License Number State | IL
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