Individual
DR. JON LESLIE SUNSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
708 8TH ST, BOONE, IA 50036-2726
(515) 432-4223
(515) 432-1054
Mailing address
708 8TH ST, BOONE, IA 50036-2726
(515) 432-4223
(515) 432-1054
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6579
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0173963
—
IA
01
—
173963
DELTA DENTAL INSURANCE
IA
Enumeration date
05/09/2007
Last updated
07/08/2007
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