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General NPI Number Information
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NPI Number | 1912438524
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Entity Type | Organization
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Legal Business Name | MICHAEL J. KUNZLER DMD, INC
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Dates
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Enumeration Date | 03/24/2017
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 2822 HIGHWAY 414
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City | LYMAN
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State | WY
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Zip | 82937-9140
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Country | US
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Telephone | 307-786-4500
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Fax | 307-786-4649
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Provider Business Mailing Address
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Address Line | 2822 HIGHWAY 414
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City | LYMAN
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State | WY
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Zip | 82937-9140
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Country | US
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Telephone | 307-786-4500
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Fax | 307-786-4649
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL JAY KUNZLER
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Credential | DMD
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Telephone | 307-786-4500
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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 | 1116
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License Number State | WY
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