Provider Demographics
NPI:1992030241
Name:LUNDELL, TROY KIRK (DMD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:KIRK
Last Name:LUNDELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USA DENTAC LANDSTUHL
Mailing Address - Street 2:CMR 402 BLDG 3703
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:US
Mailing Address - Phone:0114963719-464-4308
Mailing Address - Fax:
Practice Address - Street 1:2901 CASSIDY RD
Practice Address - Street 2:
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79916-3502
Practice Address - Country:US
Practice Address - Phone:915-742-2871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7897122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist