Provider Demographics
NPI:1225184336
Name:LUND, R RICHARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:R
Middle Name:RICHARD
Last Name:LUND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:RAYMOND
Other - Middle Name:RICHARD
Other - Last Name:LUND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:3738 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-1020
Mailing Address - Country:US
Mailing Address - Phone:203-374-9007
Mailing Address - Fax:203-374-0529
Practice Address - Street 1:3738 PARK AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-1020
Practice Address - Country:US
Practice Address - Phone:203-374-9007
Practice Address - Fax:203-374-0529
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT38351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice