Provider Demographics
NPI:1366502437
Name:LUNN, RILEY HAMILTON (DDS)
Entity type:Individual
Prefix:DR
First Name:RILEY
Middle Name:HAMILTON
Last Name:LUNN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8569
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37414
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
Practice Address - Country:US
Practice Address - Phone:423-892-5137
Practice Address - Fax:423-490-0791
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS1902122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4075161OtherBCBS
TN4075161OtherBCBS