Provider Demographics
NPI:1336200567
Name:LUND, MARK (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:LUND
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3985 W 106TH ST STE 150
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9245
Mailing Address - Country:US
Mailing Address - Phone:317-872-0173
Mailing Address - Fax:
Practice Address - Street 1:3985 W 106TH ST STE 150
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-9245
Practice Address - Country:US
Practice Address - Phone:317-872-0173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007557A1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics