MEDICARE: DR. GREGORY THOMAS KUNZ DDS

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	4874	AZ
2	1223G0001X	General Practice Dentistry	16850	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01456691	OTHER		UNITED CONCORDIA INDIV#
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1371004	OTHER		UNITED CONCORDIA GP#
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	54041	OTHER		SAFEGUARD
6	AZ0475180	OTHER	AZ	BCBS OF AZ
7	54038	OTHER		SAFEGUARD
8	828432	OTHER		UNITED CONCORDIA GP#

General Provider Information

NPI Number	:	1891884235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY THOMAS KUNZ DDS

Provider Business Mailing Address
First Line	:	3707 N TWIN CITY HWY
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-2116
Country	:	US
Telephone Number	:	409-962-9391
Fax Number	:	409-962-3932

Provider Business Practice Location Address
First Line	:	3707 N. TWIN CITY HWY.
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-2116
Country	:	US
Telephone Number	:	409-962-9391
Fax Number	:	409-962-3932

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	01/31/2018

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Directions to “ DR. GREGORY THOMAS KUNZ DDS” Practice Location

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