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Individual
TACY MARIE SUNDELL
Active
Individual
TACY MARIE SUNDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
3352
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1493112
UNITED CONCORDIA
AR
01
—
5X406
BLUE CROSS PROVIDER NUMBE
AR
Enumeration date
08/14/2006
Last updated
07/08/2007
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