Healthcare Provider Details

I. General information

NPI: 1760796767
Provider Name (Legal Business Name): MARISSA MARIE KUHNEN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 INDIANA AVE
WINSLOW AZ
86047-2169
US

IV. Provider business mailing address

1401 N 4TH ST #242
FLAGSTAFF AZ
86004-7843
US

V. Phone/Fax

Practice location:
  • Phone: 928-289-4646
  • Fax: 928-289-6291
Mailing address:
  • Phone: 814-688-2561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDS038361
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: