Healthcare Provider Details

I. General information

NPI: 1831501352
Provider Name (Legal Business Name): GARY R. KUNTZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1173 ALGONQUIN RD.
DES PLAINES IL
60016
US

IV. Provider business mailing address

1173 ALGONQUIN RD.
DES PLAINES IL
60016
US

V. Phone/Fax

Practice location:
  • Phone: 847-827-2784
  • Fax: 847-297-3830
Mailing address:
  • Phone: 847-827-2784
  • Fax: 847-297-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number01904903
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: