Healthcare Provider Details

I. General information

NPI: 1407260458
Provider Name (Legal Business Name): ASHLEY BROOKE SUNSTRUM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 29TH ST
WEST DES MOINES IA
50266-1302
US

IV. Provider business mailing address

1469 29TH ST
WEST DES MOINES IA
50266-1326
US

V. Phone/Fax

Practice location:
  • Phone: 515-223-6529
  • Fax:
Mailing address:
  • Phone: 515-223-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number09111
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: