Dr. Richard J. Sundberg D.D.S., P.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DE00004263 Issued in WA

Legal business name

DR. RICHARD J. SUNDBERG D.D.S., P.S.

Practice address

310 S 3Rd Ave
Walla Walla, WA 99362-3037

Phone

(509) 529-3762

Fax

(509) 529-7622

NPI assigned

Dec 13, 2006

Last updated

Sep 25, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Richard Jon Sundberg, D.D.S.NPI 1124295514

Title

President

Phone

(509) 529-3762

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Richard Jon Sundberg, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Walla Walla, WA
  • NPI 1124295514
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222300800000",
    "number": "1063573699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 S 3RD AVE",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993623037",
            "telephone_number": "509-529-3762",
            "fax_number": "509-529-7622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S 3RD AVE",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993623037",
            "telephone_number": "509-529-3762",
            "fax_number": "509-529-7622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. RICHARD J. SUNDBERG D.D.S., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2008-09-25",
        "status": "A",
        "authorized_official_last_name": "SUNDBERG",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-529-3762",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE00004263",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5347000",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LABOR & INDUSTRIES",
            "identifier": "0028263",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hayla Donovan
• Daniel James Doran, MD
• Eugene Joseph Dotolo, LICSW
• Jessica Dougherty-Burt
• Jennifer Douglas, RN00123804
• Lindsay Anne Drango
• Heidi Drennen
• Jason Adam Dreyer, DO
• Keeley C Drotz, RDN (REGISTERED DIET
• Kristen Michelle Duede

• Oral and Maxillofacial Surgery (Dentist) in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.