Provider Demographics
NPI:1497435978
Name:HUNSTAD TOP GUM DENTAL LLC
Entity Type:Organization
Organization Name:HUNSTAD TOP GUM DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUNSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-201-3745
Mailing Address - Street 1:145 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:TEA
Mailing Address - State:SD
Mailing Address - Zip Code:57064-2513
Mailing Address - Country:US
Mailing Address - Phone:605-201-3745
Mailing Address - Fax:
Practice Address - Street 1:145 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:TEA
Practice Address - State:SD
Practice Address - Zip Code:57064-2513
Practice Address - Country:US
Practice Address - Phone:605-201-3745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty