MEDICARE: MAKAELA MANNER KUNSTLER D.M.D.

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	122300000X	Dentist	DN18739	FL

General Provider Information

NPI Number	:	1720218076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKAELA MANNER KUNSTLER D.M.D.

Provider Business Mailing Address
First Line	:	2718 LEE BLVD STE A
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33971-1537
Country	:	US
Telephone Number	:	239-368-9036
Fax Number	:

Provider Business Practice Location Address
First Line	:	2718 LEE BLVD STE A
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33971-1537
Country	:	US
Telephone Number	:	239-368-9036
Fax Number	:

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

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	12/28/2018

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