Provider Demographics
NPI:1700402435
Name:LUNSFORD, TRISTAN (DDS)
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:
Last Name:LUNSFORD
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 1:3389 TIMBERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-1271
Mailing Address - Country:US
Mailing Address - Phone:248-787-6948
Mailing Address - Fax:
Practice Address - Street 1:227 W MONROE ST STE 205
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-5017
Practice Address - Country:US
Practice Address - Phone:312-346-0171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist