Provider Demographics
NPI:1073786992
Name:LUNDELL, CHRIS B (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:B
Last Name:LUNDELL
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 1:2100 ASBURY RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3091
Mailing Address - Country:US
Mailing Address - Phone:563-557-8262
Mailing Address - Fax:563-557-3025
Practice Address - Street 1:2100 ASBURY RD
Practice Address - Street 2:SUITE 7
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-3091
Practice Address - Country:US
Practice Address - Phone:563-557-8262
Practice Address - Fax:563-557-3025
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA63041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0151720Medicaid