Provider Demographics
NPI:1366687691
Name:LUNARDON, JAMES F (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:F
Last Name:LUNARDON
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N CANYON ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5817
Mailing Address - Country:US
Mailing Address - Phone:575-887-2444
Mailing Address - Fax:575-887-2392
Practice Address - Street 1:701 N CANYON ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5817
Practice Address - Country:US
Practice Address - Phone:575-887-2444
Practice Address - Fax:575-887-2392
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM12071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM85274Medicaid