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General NPI Number Information
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NPI Number | 1043479421
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Entity Type | Organization
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Legal Business Name | FRANK F SUNSTROM DDS & JON L SUNSTROM DDS P.C.
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 708 8TH ST
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City | BOONE
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State | IA
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Zip | 50036-2726
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Country | US
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Telephone | 515-432-4223
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Fax | 515-432-1054
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Provider Business Mailing Address
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Address Line | 708 8TH ST
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City | BOONE
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State | IA
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Zip | 50036-2726
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Country | US
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Telephone | 515-432-4223
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Fax | 515-432-1054
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JON L SUNSTROM
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Credential | DDS
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Telephone | 515-432-4223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 6579
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License Number State | IA
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