Provider Demographics
NPI:1568585628
Name:LUNDGREN, JOHN P (DDS, MS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:LUNDGREN
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:7740 POINT MEADOWS DR
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9179
Mailing Address - Country:US
Mailing Address - Phone:904-517-5090
Mailing Address - Fax:904-517-5091
Practice Address - Street 1:7740 POINT MEADOWS DR
Practice Address - Street 2:SUITE 3B
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9179
Practice Address - Country:US
Practice Address - Phone:904-517-5090
Practice Address - Fax:904-517-5091
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2009-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLDN165681223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics