| Dr. Richard J. Sundberg D.d.s., P.s. | |
|
310 S 3rd Ave Walla Walla WA 99362-3037 | |
| (509) 529-3762 | |
| (509) 529-7622 |
| Full Name | Dr. Richard J. Sundberg D.d.s., P.s. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 310 S 3rd Ave, Walla Walla, Washington |
| Authorized Official Name and Position | Richard Jon Sundberg (PRESIDENT) |
| Authorized Official Contact | 5095293762 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Richard J. Sundberg D.d.s., P.s. 310 S 3rd Ave Walla Walla WA 99362-3037 Ph: (509) 529-3762 | Dr. Richard J. Sundberg D.d.s., P.s. 310 S 3rd Ave Walla Walla WA 99362-3037 Ph: (509) 529-3762 |
| NPI Number | 1063573699 |
|---|---|
| Provider Enumeration Date | 12/13/2006 |
| Last Update Date | 09/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063573699 | NPI | - | NPPES |
| 5347000 | Medicaid | WA | |
| 0028263 | Other | WA | STATE LABOR & INDUSTRIES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DE00004263 (Washington) | Primary |
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