Provider Demographics
NPI:1245239995
Name:LUNSON, SUSAN ELAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELAINE
Last Name:LUNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4511
Mailing Address - Country:US
Mailing Address - Phone:281-592-1234
Mailing Address - Fax:281-446-1309
Practice Address - Street 1:205 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4511
Practice Address - Country:US
Practice Address - Phone:281-446-2362
Practice Address - Fax:281-446-1309
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX147811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice