=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528635604
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARIEL N. KUNDE DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2021
-----------------------------------------------------
Last Update Date | 03/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 244 LATITUDE LN STE 103
-----------------------------------------------------
City | LAKE WYLIE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29710-8125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-831-2171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11924 ANTEBELLUM DR
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28273-3610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-984-7709
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DGD.9918
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------