Provider Demographics
NPI:1013153923
Name:L. G. GUNNER DDS PC
Entity Type:Organization
Organization Name:L. G. GUNNER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:GUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-842-2101
Mailing Address - Street 1:825 E 8TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-2633
Mailing Address - Country:US
Mailing Address - Phone:605-842-2101
Mailing Address - Fax:605-842-0493
Practice Address - Street 1:825 E 8TH ST STE 203
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2633
Practice Address - Country:US
Practice Address - Phone:605-842-2101
Practice Address - Fax:605-842-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM2681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty