Active NPI
Mark Sundem
- General Practice Dentistry
- San Antonio, TX
National Provider Identifier
1508226317
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 60659999
- Practice address
- 2133 Pepperrell St BLDG 3352
San Antonio, TX 78236-5313 - Phone
- (830) 221-0459
- NPI assigned
- Mar 7, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 60659999 | WA | Primary |
Addresses
Primary practice location
2133 Pepperrell St BLDG 3352
San Antonio, TX 78236-5313
Mailing address
1722 NW 8TH Ave
Camas, WA 98607-2614
Phone (360) 448-8986
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60659999 | WA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1457308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752451200000",
"number": "1508226317",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1722 NW 8TH AVE",
"city": "CAMAS",
"state": "WA",
"postal_code": "986072614",
"telephone_number": "360-448-8986"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2133 PEPPERRELL ST BLDG 3352",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782365313",
"telephone_number": "830-221-0459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUNDEM",
"first_name": "MARK",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-03-07",
"last_updated": "2025-07-14",
"certification_date": "2025-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "60659999",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.