MEDICARE: DR. DAVID KENNETH LUNDAHL 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
1	1223D0001X	Public Health Dentistry	16071	TX

General Provider Information

NPI Number	:	1801875430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID KENNETH LUNDAHL DDS

Provider Business Mailing Address
First Line	:	56 TIMBERLINE DR
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-1963
Country	:	US
Telephone Number	:	757-827-8518
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E MAIN ST
Second Line	:	SUITE 1000
City	:	NORFOLK
State	:	VA
Zip	:	23510-1753
Country	:	US
Telephone Number	:	757-628-4331
Fax Number	:	757-628-4337

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	07/08/2007

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