Healthcare Provider Details

I. General information

NPI: 1407141849
Provider Name (Legal Business Name): DEBORAH K KUNTZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH K ANDERSON DDS

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 03/19/2023
Certification Date: 03/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 N WASHINGTON ST
SAINT CROIX FALLS WI
54024-9274
US

IV. Provider business mailing address

PO BOX 60
SAINT CROIX FALLS WI
54024-0060
US

V. Phone/Fax

Practice location:
  • Phone: 715-557-4839
  • Fax:
Mailing address:
  • Phone: 715-553-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6762-15
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12988
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: