MEDICARE: HEIDI J KUNKEL DMD

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	122300000X	Dentist	0127751	VT

General Provider Information

NPI Number	:	1356888416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI J KUNKEL DMD

Provider Business Mailing Address
First Line	:	6958 NEBRASKA AVE
Second Line	:	1608
City	:	FT LEONARD WD
State	:	MO
Zip	:	65473-1618
Country	:	US
Telephone Number	:	573-596-0411
Fax Number	:	573-596-0410

Provider Business Practice Location Address
First Line	:	6958 NEBRASKA AVE
Second Line	:	1608
City	:	FT LEONARD WD
State	:	MO
Zip	:	65473-1618
Country	:	US
Telephone Number	:	573-596-0411
Fax Number	:	573-596-0410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2017
Last Update Date	:	01/27/2017

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Directions to “ HEIDI J KUNKEL DMD” Practice Location

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