Provider Demographics
NPI:1821649864
Name:LUNDIN, CHASE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHASE
Middle Name:A
Last Name:LUNDIN
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 1:4450 W WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48329-4093
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4450 W WALTON BLVD
Practice Address - Street 2:
Practice Address - City:WATERFORD TWP
Practice Address - State:MI
Practice Address - Zip Code:48329-4093
Practice Address - Country:US
Practice Address - Phone:248-600-5827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK147370122300000X
MI2901601914122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK147370Medicaid