Provider Demographics
NPI:1821187808
Name:GUNDLER, JOSEPH GORDON (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GORDON
Last Name:GUNDLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:
Other - Last Name:GUNDLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:291 HERITAGE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BLANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45107-8353
Mailing Address - Country:US
Mailing Address - Phone:937-783-2594
Mailing Address - Fax:
Practice Address - Street 1:615 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:BLANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45107
Practice Address - Country:US
Practice Address - Phone:937-783-5505
Practice Address - Fax:937-783-5451
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0204771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice