Provider Demographics
NPI:1881604494
Name:KRISTIAN LUNDGREN KOSZEGHY DMD MMSC INC
Entity type:Organization
Organization Name:KRISTIAN LUNDGREN KOSZEGHY DMD MMSC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDGREN-KOSZEGHY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MMSC
Authorized Official - Phone:650-326-1400
Mailing Address - Street 1:850 MIDDLEFIELD RD
Mailing Address - Street 2:STE #1
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301
Mailing Address - Country:US
Mailing Address - Phone:650-326-1400
Mailing Address - Fax:650-326-2909
Practice Address - Street 1:850 MIDDLEFIELD RD
Practice Address - Street 2:STE #1
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301
Practice Address - Country:US
Practice Address - Phone:650-326-1400
Practice Address - Fax:650-326-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519671223P0300X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty