Provider Demographics
NPI:1851379838
Name:GUNNELL, THOMAS RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RICHARD
Last Name:GUNNELL
Suffix:
Gender:M
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:CHAFFEE ROAD BLDG 128
Mailing Address - Street 2:USA DENTAC FORT BLISS
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-742-5935
Mailing Address - Fax:915-742-7462
Practice Address - Street 1:5005 N PIEDRAS ST
Practice Address - Street 2:BLDG 128 CHAFFEE ROAD, FORT BLISS
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5002
Practice Address - Country:US
Practice Address - Phone:915-742-5935
Practice Address - Fax:915-742-7462
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6435122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist