Organization
QUINN L. LUNDBERG, JR., DMD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. QUINN L LUNDBERG JR. DMD (OWNER)
(814) 268-6614
Entity
Organization
Contact information
Practice address
409 MAIN ST, BROCKWAY, PA 15824-1324
(814) 268-6614
(814) 265-0087
Mailing address
409 MAIN ST, BROCKWAY, PA 15824-1324
(814) 268-6614
(814) 265-0087
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001248233-0001
—
PA
Enumeration date
03/19/2021
Last updated
03/19/2021
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