Provider Demographics
NPI:1033291687
Name:LUND, BRETT B (DDS)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:B
Last Name:LUND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:794 EASTLAND DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6856
Mailing Address - Country:US
Mailing Address - Phone:208-734-3312
Mailing Address - Fax:208-734-3313
Practice Address - Street 1:325 MARTIN ST STE B
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4563
Practice Address - Country:US
Practice Address - Phone:208-732-7447
Practice Address - Fax:208-733-5940
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-41911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDD-4191OtherIDAHO STATE BOARD OF DENTISTRY