Healthcare Provider Details

I. General information

NPI: 1821161001
Provider Name (Legal Business Name): JEFFREY R. KUNKEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 N CEDAR AVE STE 105
FRESNO CA
93720-2689
US

IV. Provider business mailing address

7525 N CEDAR AVE STE 105
FRESNO CA
93720-2689
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-6600
  • Fax: 559-439-5400
Mailing address:
  • Phone: 559-439-6600
  • Fax: 559-439-5400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00010581
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number60083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: