MEDICARE: DR. MARK SUNDEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	60659999	WA

General Provider Information

NPI Number	:	1508226317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK SUNDEM

Provider Business Mailing Address
First Line	:	1722 NW 8TH AVE
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-2614
Country	:	US
Telephone Number	:	360-448-8986
Fax Number	:

Provider Business Practice Location Address
First Line	:	2133 PEPPERRELL ST BLDG 3352
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78236-5313
Country	:	US
Telephone Number	:	830-221-0459
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2016
Last Update Date	:	07/14/2025

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Directions to “ DR. MARK SUNDEM ” Practice Location

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