Healthcare Provider Details

I. General information

NPI: 1609194935
Provider Name (Legal Business Name): MOLLY GUNSAULIS, DDS DENTISTRY FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15404 E SPRINGFIELD AVE STE 102
SPOKANE VALLEY WA
99037-8569
US

IV. Provider business mailing address

15404 E SPRINGFIELD AVE STE 102
SPOKANE VALLEY WA
99037-8569
US

V. Phone/Fax

Practice location:
  • Phone: 509-922-1333
  • Fax: 509-922-4338
Mailing address:
  • Phone: 509-922-1333
  • Fax: 509-922-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MOLLY A GUNSAULIS
Title or Position: OWNER
Credential: DDS
Phone: 509-922-1333