Provider Demographics
NPI:1689735987
Name:GUNNELL, SWETA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SWETA
Middle Name:
Last Name:GUNNELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 HWY A1A
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937
Mailing Address - Country:US
Mailing Address - Phone:321-777-4733
Mailing Address - Fax:321-777-4933
Practice Address - Street 1:1024 HWY A1A
Practice Address - Street 2:SUITE 108
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937
Practice Address - Country:US
Practice Address - Phone:321-777-4733
Practice Address - Fax:321-777-4933
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN163531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice