Provider Demographics
NPI:1306090345
Name:LJUNGBERGH, PETER A (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:LJUNGBERGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:LINDSTROM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:36101 BOB HOPE DR. SUITE B-4
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-321-4095
Mailing Address - Fax:760-321-4095
Practice Address - Street 1:36101 BOB HOPE DR.
Practice Address - Street 2:SUITE B-4
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-321-4095
Practice Address - Fax:760-321-4095
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35045122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist