Provider Demographics
NPI:1780799320
Name:NATHALIE TUNGESVIK,DDS,PC
Entity type:Organization
Organization Name:NATHALIE TUNGESVIK,DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHALIE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:TUNGESVIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-635-3576
Mailing Address - Street 1:3555 ANTIETAM CT
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6899
Mailing Address - Country:US
Mailing Address - Phone:573-893-8380
Mailing Address - Fax:
Practice Address - Street 1:994 DIAMOND RDG
Practice Address - Street 2:SUITE 200
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6885
Practice Address - Country:US
Practice Address - Phone:573-635-3576
Practice Address - Fax:573-634-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0153271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty