Provider Demographics
NPI:1194385724
Name:LUNDIN, CAMERON (DDS)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:LUNDIN
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 1:781 YOSEMITE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-8468
Mailing Address - Country:US
Mailing Address - Phone:928-486-1352
Mailing Address - Fax:
Practice Address - Street 1:1741 MESQUITE AVE STE 100B
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5686
Practice Address - Country:US
Practice Address - Phone:928-855-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0103991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice