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General NPI Number Information
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NPI Number | 1861837973
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Entity Type | Organization
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Legal Business Name | KUNNEL DENTAL CENTER P.C.
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Dates
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Enumeration Date | 05/02/2013
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Last Update Date | 05/02/2013
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Provider Practice Location Address
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Address Line | 9933 LAWLER AVE #401
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City | SKOKIE
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State | IL
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Zip | 60077-3703
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Country | US
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Telephone | 847-675-7090
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Fax |
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Provider Business Mailing Address
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Address Line | 9933 LAWLER AVE #401
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City | SKOKIE
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State | IL
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Zip | 60077-3703
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Country | US
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Telephone | 847-675-7090
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESSIE KUNNEL
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Credential | DDS
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Telephone | 847-675-5590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 019024293
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 019024836
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License Number State | IL
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