MEDICARE: DR. DANIEL JONATHAN LUNSTAD D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D12246	MN

General Provider Information

NPI Number	:	1184729865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL JONATHAN LUNSTAD D.D.S

Provider Business Mailing Address
First Line	:	4873 STEWART AVE
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-2842
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 VILLAGE CENTER DR
Second Line	:	SUITE 120
City	:	NORTH OAKS
State	:	MN
Zip	:	55127-3019
Country	:	US
Telephone Number	:	651-490-9011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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