MEDICARE: MAKAELA MANNER KUNSTLER, DMD, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17202218076	OTHER	FL	NPI

General Provider Information

NPI Number	:	1306478243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAKAELA MANNER KUNSTLER, DMD, PA

Provider Business Mailing Address
First Line	:	2905 DAVIS BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34104-4338
Country	:	US
Telephone Number	:	239-674-3311
Fax Number	:	239-244-8742

Provider Business Practice Location Address
First Line	:	2905 DAVIS BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34104-4338
Country	:	US
Telephone Number	:	239-674-3311
Fax Number	:	239-244-8742

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MAKAELA MANNER KUNSTLER
Credential	:	DMD
Telephone Number	:	239-821-2654

Provider Enumeration Date	:	02/09/2020
Last Update Date	:	02/09/2020

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