Healthcare Provider Details

I. General information

NPI: 1144280421
Provider Name (Legal Business Name): WILLIAM THOMAS KUNKEL JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 E LIBERTY STREET
GIRARD OH
44420
US

IV. Provider business mailing address

1041 E LIBERTY STREET PO BOX 430
GIRARD OH
44420
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-8425
  • Fax: 330-759-8425
Mailing address:
  • Phone: 330-759-8425
  • Fax: 330-759-8425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15772
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: