Provider Demographics
NPI:1568680833
Name:SUNDAHL, LANA JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LANA
Middle Name:JEAN
Last Name:SUNDAHL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 UNIVERSITY DR
Mailing Address - Street 2:#1-A
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4203
Mailing Address - Country:US
Mailing Address - Phone:659-329-0167
Mailing Address - Fax:
Practice Address - Street 1:1300 UNIVERSITY DR
Practice Address - Street 2:#1-A
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4203
Practice Address - Country:US
Practice Address - Phone:659-329-0167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice