Provider Demographics
NPI:1598449688
Name:GHASSEMLOUEI AND GUNDERSON DENTAL PRACTICE PLLC
Entity Type:Organization
Organization Name:GHASSEMLOUEI AND GUNDERSON DENTAL PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-617-3683
Mailing Address - Street 1:2418 ENTERPRISE DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1361
Mailing Address - Country:US
Mailing Address - Phone:651-452-2116
Mailing Address - Fax:651-452-2695
Practice Address - Street 1:2418 ENTERPRISE DR UNIT B
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1361
Practice Address - Country:US
Practice Address - Phone:651-452-2116
Practice Address - Fax:651-452-2695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty