MEDICARE: RANDALL L KUNIK D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	15429	TX

General Provider Information

NPI Number	:	1568510600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL L KUNIK D.D.S.

Provider Business Mailing Address
First Line	:	4201 BEE CAVE RD
Second Line	:	C209
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6465
Country	:	US
Telephone Number	:	512-327-8818
Fax Number	:	512-327-1018

Provider Business Practice Location Address
First Line	:	3423 BEE CAVES RD # C202
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-7180
Country	:	US
Telephone Number	:	512-327-8818
Fax Number	:	512-327-1018

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	01/13/2025

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