Provider Demographics
NPI:1376047738
Name:GUNNELL DDS AND VAN OOSTENDORP DDS
Entity Type:Organization
Organization Name:GUNNELL DDS AND VAN OOSTENDORP DDS
Other - Org Name:MARION FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-652-6967
Mailing Address - Street 1:55 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-4935
Mailing Address - Country:US
Mailing Address - Phone:828-652-6967
Mailing Address - Fax:
Practice Address - Street 1:55 MORGAN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-4935
Practice Address - Country:US
Practice Address - Phone:828-652-6967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUNNELL DDS AND VAN OOSTENDORP DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty