Provider Demographics
NPI:1609121938
Name:SUSAN E. LUNSON, DDS, PA
Entity Type:Organization
Organization Name:SUSAN E. LUNSON, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-446-2362
Mailing Address - Street 1:80 WILSON RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-3961
Mailing Address - Country:US
Mailing Address - Phone:281-446-2362
Mailing Address - Fax:281-446-1309
Practice Address - Street 1:80 WILSON RD
Practice Address - Street 2:SUITE C
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3961
Practice Address - Country:US
Practice Address - Phone:281-446-2362
Practice Address - Fax:281-446-1309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX147811223G0001X
TX13162339011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty