Provider Demographics
NPI:1043430648
Name:LUNN, ANGELA GARNER (DDS)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:GARNER
Last Name:LUNN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:GARNER
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5323 BRAINERD ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411
Mailing Address - Country:US
Mailing Address - Phone:423-892-5137
Mailing Address - Fax:423-490-0791
Practice Address - Street 1:5323 BRAINERD ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411
Practice Address - Country:US
Practice Address - Phone:423-892-5137
Practice Address - Fax:423-490-0791
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0003091SCOtherDELTA DENTAL OF MISSOURI
SC570922234OtherBCBS
SCZ30912Medicaid