Provider Demographics
NPI:1881754679
Name:LUNSTAD, GARY (DDS, MSD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:LUNSTAD
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 1:700 VILLAGE CENTER DR
Mailing Address - Street 2:#140
Mailing Address - City:NORTH OAKS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-3019
Mailing Address - Country:US
Mailing Address - Phone:651-490-3155
Mailing Address - Fax:651-490-1280
Practice Address - Street 1:700 VILLAGE CENTER DR
Practice Address - Street 2:#140
Practice Address - City:NORTH OAKS
Practice Address - State:MN
Practice Address - Zip Code:55127-3019
Practice Address - Country:US
Practice Address - Phone:651-490-3155
Practice Address - Fax:651-490-1280
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN71091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics