# LUNDGRIN DENTAL ASSOCIATION CHTD.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245367077
- **Authorized official:** DR. JERRY R LUNDGRIN DDS (PRESIDENT)
- **Authorized official phone:** (785) 825-5473

## Contact information

- **Practice address:** 909 E WAYNE AVE, SALINA, KS 67401-2201
- **Practice address phone:** (785) 825-5473
- **Practice address fax:** (785) 825-8965
- **Mailing address:** PO BOX 1424, SALINA, KS 67402-1424
- **Mailing address phone:** (785) 825-5473
- **Mailing address fax:** (785) 825-8965

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4696 | KS | Yes |
| 1223G0001X | General Practice Dentistry | 6929 | KS | — |

## Other

- **Enumeration date:** 02/28/2007
- **Last updated:** 08/22/2020