Healthcare Provider Details

I. General information

NPI: 1851453815
Provider Name (Legal Business Name): JENNIFER ANN KUNKEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12815 HIGHWAY 36
NEEDVILLE TX
77461-8112
US

IV. Provider business mailing address

PO BOX 1627
NEEDVILLE TX
77461-1627
US

V. Phone/Fax

Practice location:
  • Phone: 979-793-5566
  • Fax:
Mailing address:
  • Phone: 979-793-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20204
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: