Provider Demographics
NPI:1659486298
Name:TUNGESVIK, NATHALIE LOUISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHALIE
Middle Name:LOUISE
Last Name:TUNGESVIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 ANTIETAM CT
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6899
Mailing Address - Country:US
Mailing Address - Phone:573-893-8380
Mailing Address - Fax:573-634-2597
Practice Address - Street 1:994 DIAMOND RDG
Practice Address - Street 2:SUITE 200
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6885
Practice Address - Country:US
Practice Address - Phone:573-635-3576
Practice Address - Fax:573-634-2597
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0153271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice