Provider Demographics
NPI:1518030048
Name:LUNDQUIST, JON R (DDS)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:R
Last Name:LUNDQUIST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-1231
Mailing Address - Country:US
Mailing Address - Phone:724-238-9553
Mailing Address - Fax:814-723-2355
Practice Address - Street 1:226 N MARKET ST
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-1231
Practice Address - Country:US
Practice Address - Phone:724-238-9553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027796L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018225820001Medicaid
PA10037884990001Medicaid