Richard Jon Sundberg, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DE00004263 Issued in WA

Practice address

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

Phone

(509) 529-3762

Fax

(509) 529-7622

NPI assigned

May 14, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210723200000",
    "number": "1124295514",
    "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": {
        "last_name": "SUNDBERG",
        "first_name": "RICHARD",
        "middle_name": "JON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-14",
        "last_updated": "2008-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE00004263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suasor Mentis, PLLC
• Derek E Sucharda, PAC
• Kyle Sullivan, DMD
• Haley Elizabeth Sumner
• Andi Lee Sundberg
• Sunrise Family Counseling, LLC
• Surgical Specialists Field & Newbold PLLC
• Michelle Leanne Swenson, MA LMHC
• Erin Swift, OTR/L
• Erica Swingholm Mireles

• 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 May 14, 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.