Provider Demographics
NPI:1285067249
Name:LUNDGREN, BRITTA LEE (DMD)
Entity type:Individual
Prefix:DR
First Name:BRITTA
Middle Name:LEE
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 MILITARY CUTOFF RD STE 105
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3692
Mailing Address - Country:US
Mailing Address - Phone:910-233-4236
Mailing Address - Fax:
Practice Address - Street 1:1427 MILITARY CUTOFF RD STE 105
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3692
Practice Address - Country:US
Practice Address - Phone:910-233-4236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC105851223G0001X
SC8273122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice