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General NPI Number Information
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NPI Number | 1023215712
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Entity Type | Organization
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Legal Business Name | LARRY KUNKLE, DDS, APC
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 78640 HIGHWAY 111
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City | LA QUINTA
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State | CA
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Zip | 92253-2048
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Country | US
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Telephone | 760-564-0955
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Fax |
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Provider Business Mailing Address
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Address Line | 78670 HIGHWAY 111 PMB 215
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City | LA QUINTA
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State | CA
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Zip | 92253-2048
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Country | US
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Telephone | 760-564-0955
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Fax |
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Authorized Official
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Title or Position | PRACTITONER
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Name | LARRY KUNKLE
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Credential | DDS
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Telephone | 760-564-0955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 23336
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License Number State | CA
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