Provider Demographics
NPI:1124041454
Name:SUNDBERG, VISEH (DDS)
Entity type:Individual
Prefix:MRS
First Name:VISEH
Middle Name:
Last Name:SUNDBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:VISEH
Other - Middle Name:
Other - Last Name:MOVAREKHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:735 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-4631
Mailing Address - Country:US
Mailing Address - Phone:503-720-6669
Mailing Address - Fax:503-546-5474
Practice Address - Street 1:530 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-391-2219
Practice Address - Fax:503-391-4239
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD77351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice