MEDICARE: DR. SUSAN ELAINE LUNSON 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	1223G0001X	General Practice Dentistry	14781	TX

General Provider Information

NPI Number	:	1245239995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN ELAINE LUNSON D.D.S.

Provider Business Mailing Address
First Line	:	205 E HOUSTON ST
Second Line	:
City	:	CLEVELAND
State	:	TX
Zip	:	77327-4511
Country	:	US
Telephone Number	:	281-592-1234
Fax Number	:	281-446-1309

Provider Business Practice Location Address
First Line	:	205 E HOUSTON ST
Second Line	:
City	:	CLEVELAND
State	:	TX
Zip	:	77327-4511
Country	:	US
Telephone Number	:	281-446-2362
Fax Number	:	281-446-1309

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	07/07/2020

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