Provider Demographics
NPI:1538246319
Name:LUND, MICHELLE DENISE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DENISE
Last Name:LUND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2693
Mailing Address - Country:US
Mailing Address - Phone:207-221-4784
Mailing Address - Fax:507-934-0148
Practice Address - Street 1:1 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2617
Practice Address - Country:US
Practice Address - Phone:207-221-4784
Practice Address - Fax:507-934-0148
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11547122300000X
MEDEN5286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN719415300Medicaid