Provider Demographics
NPI:1184297095
Name:LUNDY, SYDNEY (DMD)
Entity type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:
Last Name:LUNDY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20009 HOLLY LAKE PL
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5030
Mailing Address - Country:US
Mailing Address - Phone:813-362-3086
Mailing Address - Fax:
Practice Address - Street 1:137 HARBOR VILLAGE LN
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-3426
Practice Address - Country:US
Practice Address - Phone:813-544-7003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26128122300000X
TN11672122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist