Provider Demographics
NPI:1265454862
Name:LUNDERMAN, LOIS JOHNSON (DDS)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:JOHNSON
Last Name:LUNDERMAN
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 1:395 VALPARAISO PKWY
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:FL
Mailing Address - Zip Code:32580-1203
Mailing Address - Country:US
Mailing Address - Phone:850-678-2012
Mailing Address - Fax:
Practice Address - Street 1:395 VALPARAISO PKWY
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:FL
Practice Address - Zip Code:32580-1203
Practice Address - Country:US
Practice Address - Phone:850-678-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13619122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist