Healthcare Provider Details

I. General information

NPI: 1114854858
Provider Name (Legal Business Name): CHASE THOMAS GUNDERSEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 UNIVERSITY BLVD STE 3145
INDIANAPOLIS IN
46202-5149
US

IV. Provider business mailing address

868 W 4230 N
PLEASANT GROVE UT
84062-8737
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-5315
  • Fax:
Mailing address:
  • Phone: 801-458-8226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number12014966A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: