Provider Demographics
NPI:1801875430
Name:LUNDAHL, DAVID KENNETH (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KENNETH
Last Name:LUNDAHL
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 1:56 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1963
Mailing Address - Country:US
Mailing Address - Phone:757-827-8518
Mailing Address - Fax:
Practice Address - Street 1:300 E MAIN ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1753
Practice Address - Country:US
Practice Address - Phone:757-628-4331
Practice Address - Fax:757-628-4337
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160711223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health