Provider Demographics
NPI:1629694385
Name:JON R LUNDQUIST DDS
Entity Type:Organization
Organization Name:JON R LUNDQUIST DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-238-9553
Mailing Address - Street 1:226 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-1236
Mailing Address - Country:US
Mailing Address - Phone:724-238-9553
Mailing Address - Fax:724-238-9435
Practice Address - Street 1:226 N MARKET ST
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-1236
Practice Address - Country:US
Practice Address - Phone:724-238-9553
Practice Address - Fax:724-238-9435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty