Provider Demographics
NPI:1639372758
Name:LUND, TIMOTHY RONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RONALD
Last Name:LUND
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 1:165 HARVESTER LN
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-9298
Mailing Address - Country:US
Mailing Address - Phone:406-570-1234
Mailing Address - Fax:
Practice Address - Street 1:127 VILLAGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-9617
Practice Address - Country:US
Practice Address - Phone:406-388-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice