Provider Demographics
NPI:1063061992
Name:SUNDBY DENTAL LLC
Entity type:Organization
Organization Name:SUNDBY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:MISSURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-360-3819
Mailing Address - Street 1:1613 BROOKDALE DR
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-1198
Mailing Address - Country:US
Mailing Address - Phone:913-360-3819
Mailing Address - Fax:
Practice Address - Street 1:222 N 7TH ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-2427
Practice Address - Country:US
Practice Address - Phone:913-367-3473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental