Provider Demographics
NPI:1033148309
Name:LUNSTRUM, THOMAS J (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:LUNSTRUM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 WILLARD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7991
Mailing Address - Country:US
Mailing Address - Phone:321-631-1492
Mailing Address - Fax:321-631-1423
Practice Address - Street 1:96 WILLARD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7991
Practice Address - Country:US
Practice Address - Phone:321-631-1492
Practice Address - Fax:321-631-1423
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN156931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice