Healthcare Provider Details

I. General information

NPI: 1427171446
Provider Name (Legal Business Name): KEVIN L KUNARD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 FREMONT LAKE RD
PINEDALE WY
82941
US

IV. Provider business mailing address

33 FREMONT LAKE RD P O BOX 803
PINEDALE WY
82941
US

V. Phone/Fax

Practice location:
  • Phone: 307-367-3700
  • Fax: 307-367-3701
Mailing address:
  • Phone: 307-367-3700
  • Fax: 307-367-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberWY1036
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: