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Organization
GUNDERSEN DENTAL, PLLC
Active
Organization
GUNDERSEN DENTAL, PLLC
Active
Other names
Tyler B. Gundersen, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TYLER BURTON GUNDERSEN D.D.S. (OWNER)
(509) 663-4436
Entity
Organization
Contact information
Practice address
251 N. CHELAN AVE, WENATCHEE, WA 98801
(509) 663-4436
(509) 663-5974
Mailing address
251 N. CHELAN AVE, WENATCHEE, WA 98801
(509) 663-4436
(509) 663-5974
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
NULL
122300000X
Dentist
Primary
—
—
261QD0000X
Dental Clinic/Center
DE00010222
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5048871
—
WA
Enumeration date
08/03/2016
Last updated
03/09/2020
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