Provider Demographics
NPI:1336508779
Name:LUNDGREN, MELISSA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 PARK MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2559
Mailing Address - Country:US
Mailing Address - Phone:303-790-2323
Mailing Address - Fax:
Practice Address - Street 1:7430 PARK MEADOWS DR
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2559
Practice Address - Country:US
Practice Address - Phone:303-790-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-13
Last Update Date:2016-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.0000903427124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist