Active NPI
Nicandra Lundstrom
- General Practice Dentistry
National Provider Identifier
1952762718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8787
- Practice address
- 86 MDG
Unit 3215
Apo, AE 09094 - Phone
- (314) 479-2115
- NPI assigned
- Mar 8, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8787 | SC | Primary |
Addresses
Primary practice location
86 MDG
Unit 3215
Apo, AE 09094
Mailing address
45 Sycamore Ave Apt 537
Charleston, SC 29407-6721
Phone (864) 353-1673
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8787 | SC | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dfas-JFLL/in | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- NPI 1639528441
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1457395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632960000000",
"number": "1952762718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45 SYCAMORE AVE APT 537",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294076721",
"telephone_number": "864-353-1673"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "MIL",
"address_1": "86 MDG",
"address_2": "UNIT 3215",
"city": "APO",
"state": "AE",
"postal_code": "09094",
"telephone_number": "314-479-2115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUNDSTROM",
"first_name": "NICANDRA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-03-08",
"last_updated": "2021-09-30",
"certification_date": "2021-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "8787",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.