Provider Demographics
NPI:1811680705
Name:PEDIATRIC DENTAL ANESTHESIOLOGISTS PLLC
Entity type:Organization
Organization Name:PEDIATRIC DENTAL ANESTHESIOLOGISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:GUNSELMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:DO
Authorized Official - Phone:509-212-8098
Mailing Address - Street 1:920 W COMSTOCK CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-1408
Mailing Address - Country:US
Mailing Address - Phone:509-212-8098
Mailing Address - Fax:
Practice Address - Street 1:9711 N NEVADA ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-3412
Practice Address - Country:US
Practice Address - Phone:509-755-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty