# GUNDERSEN DENTAL, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tyler B. Gundersen, PLLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114470432
- **Authorized official:** DR. TYLER BURTON GUNDERSEN D.D.S. (OWNER)
- **Authorized official phone:** (509) 663-4436

## Contact information

- **Practice address:** 251 N. CHELAN AVE, WENATCHEE, WA 98801
- **Practice address phone:** (509) 663-4436
- **Practice address fax:** (509) 663-5974
- **Mailing address:** 251 N. CHELAN AVE, WENATCHEE, WA 98801
- **Mailing address phone:** (509) 663-4436
- **Mailing address fax:** (509) 663-5974

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |
| 261QD0000X | Dental Clinic/Center | DE00010222 | WA | — |

## Other

- **Enumeration date:** 08/03/2016
- **Last updated:** 03/09/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5048871 | — | WA |