Healthcare Provider Details

I. General information

NPI: 1598874273
Provider Name (Legal Business Name): THOMAS CRAIG KUNKEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 FREEPORT ROAD
PITTSBURGH PA
15238
US

IV. Provider business mailing address

1330 FREEPORT ROAD
PITTSBURGH PA
15238
US

V. Phone/Fax

Practice location:
  • Phone: 412-963-8630
  • Fax: 412-967-9788
Mailing address:
  • Phone: 412-963-8630
  • Fax: 412-967-9788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDS 024763-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: