Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | ND1380 | ND |
NPI | 1003026337 |
---|---|
Provider Name | Dr. James Fred Lundstrom |
First Address | Fargo, ND 58104 |
Second Address | Fargo, ND 58104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |