Provider Demographics
NPI:1881944593
Name:LUNDY, SCOTT R (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:LUNDY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 AUBURN CT
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3614
Mailing Address - Country:US
Mailing Address - Phone:805-496-4247
Mailing Address - Fax:805-496-9830
Practice Address - Street 1:176 AUBURN CT
Practice Address - Street 2:SUITE 5
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3614
Practice Address - Country:US
Practice Address - Phone:805-496-4247
Practice Address - Fax:805-496-9830
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA617201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice