Provider Demographics
NPI:1700966348
Name:GUNNERSON, KRISTOPHER CHEYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:CHEYN
Last Name:GUNNERSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 W 300 S
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-2801
Mailing Address - Country:US
Mailing Address - Phone:801-465-3233
Mailing Address - Fax:801-331-0013
Practice Address - Street 1:33 WEST 300 SOUTH
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651
Practice Address - Country:US
Practice Address - Phone:801-465-4772
Practice Address - Fax:801-465-4850
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3239461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
868450OtherUNITED CONCORDIA