Healthcare Provider Details

I. General information

NPI: 1154555142
Provider Name (Legal Business Name): JESSIE KUNNEL D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9933 LAWLER AVE STE 401
SKOKIE IL
60077-3726
US

IV. Provider business mailing address

9933 LAWLER AVE STE 401
SKOKIE IL
60077-3726
US

V. Phone/Fax

Practice location:
  • Phone: 847-675-5590
  • Fax:
Mailing address:
  • Phone: 847-675-5590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019024836
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number019024293
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: