| NPI | 1194802918 |
|---|---|
| Former Name | DONALD JACKMAN LUNDGREN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: HI HI898) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 20227) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |