MEDICARE: VAN OOSTENDORP DDS AND GUNNELL DDS PLLC

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	8913	NC

General Provider Information

NPI Number	:	1518411974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAN OOSTENDORP DDS AND GUNNELL DDS PLLC

Provider Business Mailing Address
First Line	:	4 MARKET ST STE 4202
Second Line	:
City	:	BREVARD
State	:	NC
Zip	:	28712-5641
Country	:	US
Telephone Number	:	828-884-3702
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 MARKET ST STE 4202
Second Line	:
City	:	BREVARD
State	:	NC
Zip	:	28712-5641
Country	:	US
Telephone Number	:	828-884-3702
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BARTEL VAN OOSTENDORP
Credential	:	DDS
Telephone Number	:	828-707-2414

Provider Enumeration Date	:	08/15/2016
Last Update Date	:	08/15/2016

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