Provider Demographics
NPI:1902814650
Name:CHRIS B LUNDELL DDS PC
Entity Type:Organization
Organization Name:CHRIS B LUNDELL DDS PC
Other - Org Name:PINES FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:LUNDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-557-8262
Mailing Address - Street 1:2100 ASBURY RD
Mailing Address - Street 2:#7
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3091
Mailing Address - Country:US
Mailing Address - Phone:563-557-8262
Mailing Address - Fax:563-557-3025
Practice Address - Street 1:2100 ASBURY RD
Practice Address - Street 2:#7
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-3091
Practice Address - Country:US
Practice Address - Phone:563-557-8262
Practice Address - Fax:563-557-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0151720Medicaid