| NPI | 1114470432 |
|---|---|
| Former Legal Business Name | TYLER B. GUNDERSEN, PLLC |
| Entity Type | Organization |
| Authorized Contact | TYLER BURTON GUNDERSEN Owner 509-663-4436 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: WA DE00010222) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2020-03-09 |