Provider Demographics
NPI:1063033660
Name:GUNNELL FAMILY DENTISTRY
Entity Type:Organization
Organization Name:GUNNELL FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:STOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-752-1744
Mailing Address - Street 1:1320 N 600 E STE 2
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2474
Mailing Address - Country:US
Mailing Address - Phone:435-752-1744
Mailing Address - Fax:435-213-3639
Practice Address - Street 1:26 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HYRUM
Practice Address - State:UT
Practice Address - Zip Code:84319-1292
Practice Address - Country:US
Practice Address - Phone:435-752-1744
Practice Address - Fax:435-245-7849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty