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NPI Code Detail

MEDICARE: DR. JORDAN BLAINE LUNDEEN DDS

MEDICARE: DR. JORDAN BLAINE LUNDEEN DDS
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
11223G0001XGeneral Practice Dentistry8206OK

General Provider Information

NPI Number : 1477498566
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JORDAN BLAINE LUNDEEN DDS
Provider Business Mailing Address
First Line : 3000 DRAKE CREST DR
Second Line :
City : EDMOND
State : OK
Zip : 73034-0018
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2828 NW 30TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-7404
Country : US
Telephone Number : 405-402-4680
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2026
Last Update Date : 04/23/2026

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