Provider Demographics
NPI:1063508687
Name:GUNNELL, STEVEN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:GUNNELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEVEN
Other - Middle Name:J
Other - Last Name:GUNNELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:107 N GREENFIELD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-7802
Mailing Address - Country:US
Mailing Address - Phone:480-832-5190
Mailing Address - Fax:480-654-9900
Practice Address - Street 1:107 N GREENFIELD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-7802
Practice Address - Country:US
Practice Address - Phone:480-832-5190
Practice Address - Fax:480-654-9900
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ17051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice