MEDICARE: SUSAN E LUNSON

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1255001475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN E LUNSON

Provider Business Mailing Address
First Line	:	205 E HOUSTON ST
Second Line	:
City	:	CLEVELAND
State	:	TX
Zip	:	77327-4511
Country	:	US
Telephone Number	:	281-507-0652
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 E HOUSTON ST
Second Line	:
City	:	CLEVELAND
State	:	TX
Zip	:	77327-4511
Country	:	US
Telephone Number	:	281-507-0652
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUSAN LUNSON
Credential	:
Telephone Number	:	281-507-0652

Provider Enumeration Date	:	09/18/2021
Last Update Date	:	09/18/2021

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Directions to “SUSAN E LUNSON ” Practice Location

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