Provider Demographics
NPI:1609194935
Name:MOLLY GUNSAULIS, DDS DENTISTRY FOR CHILDREN
Entity Type:Organization
Organization Name:MOLLY GUNSAULIS, DDS DENTISTRY FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUNSAULIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-922-1333
Mailing Address - Street 1:15404 E SPRINGFIELD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-8569
Mailing Address - Country:US
Mailing Address - Phone:509-922-1333
Mailing Address - Fax:509-922-4338
Practice Address - Street 1:15404 E SPRINGFIELD AVE STE 102
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-8569
Practice Address - Country:US
Practice Address - Phone:509-922-1333
Practice Address - Fax:509-922-4338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty