Healthcare Provider Details

I. General information

NPI: 1982180790
Provider Name (Legal Business Name): HEATHER STEPHANIE KUNEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2018
Last Update Date: 07/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E FORDHAM RD
BRONX NY
10458-5046
US

IV. Provider business mailing address

555 E FORDHAM RD
BRONX NY
10458-5046
US

V. Phone/Fax

Practice location:
  • Phone: 347-801-8888
  • Fax:
Mailing address:
  • Phone: 347-801-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number059152
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: