Provider Demographics
NPI:1942343868
Name:GUNDERSON, JOHN K (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:K
Last Name:GUNDERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25109 JEFFERSON AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8119
Mailing Address - Country:US
Mailing Address - Phone:951-461-7000
Mailing Address - Fax:951-461-1211
Practice Address - Street 1:41715 WINCHESTER RD STE 207
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4854
Practice Address - Country:US
Practice Address - Phone:951-296-0211
Practice Address - Fax:951-296-0212
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA367611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice