Provider Demographics
NPI:1043828221
Name:GUNDERMAN, LAUREN VICTORIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:VICTORIA
Last Name:GUNDERMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 E BOSWELL ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-5727
Mailing Address - Country:US
Mailing Address - Phone:870-612-7177
Mailing Address - Fax:
Practice Address - Street 1:635 E BOSWELL ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-4608
Practice Address - Country:US
Practice Address - Phone:870-698-1837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4440122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4440OtherARKANSAS STATE BOARD OF DENTAL EXAMINERS