Provider Demographics
NPI:1043479421
Name:FRANK F SUNSTROM DDS & JON L SUNSTROM DDS P.C.
Entity Type:Organization
Organization Name:FRANK F SUNSTROM DDS & JON L SUNSTROM DDS P.C.
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUNSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-432-4223
Mailing Address - Street 1:708 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-2726
Mailing Address - Country:US
Mailing Address - Phone:515-432-4223
Mailing Address - Fax:515-432-1054
Practice Address - Street 1:708 8TH ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-2726
Practice Address - Country:US
Practice Address - Phone:515-432-4223
Practice Address - Fax:515-432-1054
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NONE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6579261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1841404910Medicaid