Provider Demographics
NPI:1205131026
Name:LUNDGREEN, CYNTHIA (RDH)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:LUNDGREEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 S IRVING PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-2170
Mailing Address - Country:US
Mailing Address - Phone:509-735-4660
Mailing Address - Fax:
Practice Address - Street 1:343 WELLSIAN WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4107
Practice Address - Country:US
Practice Address - Phone:509-943-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00006190124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist