Provider Demographics
NPI:1518411974
Name:VAN OOSTENDORP DDS AND GUNNELL DDS PLLC
Entity Type:Organization
Organization Name:VAN OOSTENDORP DDS AND GUNNELL DDS PLLC
Other - Org Name:CAROLINA SMILES FAMILY DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN OOSTENDORP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-707-2414
Mailing Address - Street 1:4 MARKET ST STE 4202
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-5641
Mailing Address - Country:US
Mailing Address - Phone:828-884-3702
Mailing Address - Fax:
Practice Address - Street 1:4 MARKET ST STE 4202
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-5641
Practice Address - Country:US
Practice Address - Phone:828-884-3702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC89131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty