Provider Demographics
NPI:1730190406
Name:LUND, RONALD ALBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ALBERT
Last Name:LUND
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 1:7819 NE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-9601
Mailing Address - Country:US
Mailing Address - Phone:360-546-1106
Mailing Address - Fax:360-546-0782
Practice Address - Street 1:7819 NE 13TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-9601
Practice Address - Country:US
Practice Address - Phone:360-546-1106
Practice Address - Fax:360-546-0782
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA32531223G0001X
TX78941223G0001X
WI18071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5362207Medicaid