Provider Demographics
NPI:1487794558
Name:LUND, JOHN R (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:LUND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:20445 PROSPECT RD
Mailing Address - Street 2:6
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-4662
Mailing Address - Country:US
Mailing Address - Phone:408-253-3003
Mailing Address - Fax:408-253-3064
Practice Address - Street 1:20445 PROSPECT RD
Practice Address - Street 2:6
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-4662
Practice Address - Country:US
Practice Address - Phone:408-253-3003
Practice Address - Fax:408-253-3064
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA258191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice