Healthcare Provider Details

I. General information

NPI: 1306809694
Provider Name (Legal Business Name): HARRY EUGENE KUNSELMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 MAIN ST
REYNOLDSVILLE PA
15851-1250
US

IV. Provider business mailing address

473 MAIN ST PO BOX 6
REYNOLDSVILLE PA
15851-1250
US

V. Phone/Fax

Practice location:
  • Phone: 814-653-2227
  • Fax: 814-653-2227
Mailing address:
  • Phone: 814-653-2227
  • Fax: 814-653-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS021864L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: