Provider Demographics
NPI:1649679002
Name:RILEY H LUNN DDS PLLC
Entity type:Organization
Organization Name:RILEY H LUNN DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RILEY
Authorized Official - Middle Name:H
Authorized Official - Last Name:LUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-892-5137
Mailing Address - Street 1:5323 BRAINERD RD
Mailing Address - Street 2:106
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-5305
Mailing Address - Country:US
Mailing Address - Phone:423-892-5137
Mailing Address - Fax:423-490-0791
Practice Address - Street 1:5323 BRAINERD RD
Practice Address - Street 2:SUITE 106
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5305
Practice Address - Country:US
Practice Address - Phone:423-892-5137
Practice Address - Fax:423-490-0791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4709122300000X
TN1902122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7403780001Medicare NSC