MEDICARE: DR. TERRY LYNN KUNKLE SR. 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	SC 1641	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528068236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY LYNN KUNKLE SR. DMD

Provider Business Mailing Address
First Line	:	119 LIBRARY ST
Second Line	:
City	:	MONCKS CORNER
State	:	SC
Zip	:	29461-3751
Country	:	US
Telephone Number	:	843-761-8065
Fax Number	:	843-761-5085

Provider Business Practice Location Address
First Line	:	119 LIBRARY ST
Second Line	:
City	:	MONCKS CORNER
State	:	SC
Zip	:	29461-3751
Country	:	US
Telephone Number	:	843-761-8065
Fax Number	:	843-761-5085

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	07/08/2007

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