Provider Demographics
NPI:1487025391
Name:DUBUQUE ENDODONTICS, PC
Entity Type:Organization
Organization Name:DUBUQUE ENDODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LUNDSTROM
Authorized Official - Suffix:I
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:563-583-1050
Mailing Address - Street 1:988 W 3RD ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6666
Mailing Address - Country:US
Mailing Address - Phone:563-583-1050
Mailing Address - Fax:
Practice Address - Street 1:988 W 3RD ST
Practice Address - Street 2:SUITE 107
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6666
Practice Address - Country:US
Practice Address - Phone:563-583-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-090701223E0200X
IADDS-089531223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty