Provider Demographics
NPI:1538265954
Name:GUNDERSEN, TYLER B (DDS, PLLC)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:B
Last Name:GUNDERSEN
Suffix:
Gender:M
Credentials:DDS, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2104
Mailing Address - Country:US
Mailing Address - Phone:509-663-4436
Mailing Address - Fax:509-663-5794
Practice Address - Street 1:251 N CHELAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2104
Practice Address - Country:US
Practice Address - Phone:509-663-4436
Practice Address - Fax:509-663-5794
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000102221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice