MEDICARE: DR. TROY KIRK LUNDELL DMD

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	D7897	AZ
2	1223G0001X	General Practice Dentistry	D7897	AZ

General Provider Information

NPI Number	:	1992030241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TROY KIRK LUNDELL DMD

Provider Business Mailing Address
First Line	:	USA DENTAC LANDSTUHL
Second Line	:	CMR 402 BLDG 3703
City	:	APO
State	:	AE
Zip	:	09180
Country	:	US
Telephone Number	:	01149637194644308
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 CASSIDY RD
Second Line	:
City	:	FORT BLISS
State	:	TX
Zip	:	79916-3502
Country	:	US
Telephone Number	:	915-742-2871
Fax Number	:

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

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	04/07/2023

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