Individual
DR. BROC GUNDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1450 1ST AVE SW, QUINCY, WA 98848-1695
(509) 787-0715
Mailing address
1450 1ST AVE SW, QUINCY, WA 98848-1695
(509) 787-0715
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE60477428
WA
Other
Enumeration date
07/02/2014
Last updated
09/05/2014
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