Provider Demographics
NPI:1285840256
Name:GUNSAULIS, MOLLY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:A
Last Name:GUNSAULIS
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 1:16722 E INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-8528
Mailing Address - Country:US
Mailing Address - Phone:509-995-0910
Mailing Address - Fax:
Practice Address - Street 1:15404 E SPRINGFIELD AVE
Practice Address - Street 2:102
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037
Practice Address - Country:US
Practice Address - Phone:509-922-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000087521223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry