Provider Demographics
NPI:1205055423
Name:LUNT, RAY EUGENE (DDS)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:EUGENE
Last Name:LUNT
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 1:1805 E NOB HILL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5237
Mailing Address - Country:US
Mailing Address - Phone:503-364-9515
Mailing Address - Fax:503-365-9713
Practice Address - Street 1:1805 E NOB HILL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5237
Practice Address - Country:US
Practice Address - Phone:503-364-9515
Practice Address - Fax:503-365-9713
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR66121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice