Provider Demographics
NPI:1194980573
Name:LUND, NATHAN ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ROBERT
Last Name:LUND
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:622 ROOSEVELT RD 180
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-6361
Mailing Address - Country:US
Mailing Address - Phone:320-259-5078
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF THE ARMY DENTAL ACTIVITY STOP
Practice Address - Street 2:2817 REILLY RD, MCDS-NA-B
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-396-5610
Practice Address - Fax:910-396-7017
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2015-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MND125271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice