MEDICARE: KAI D FUNKE DDS LTD

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	3183	NV

General Provider Information

NPI Number	:	1558607937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAI D FUNKE DDS LTD

Provider Business Mailing Address
First Line	:	805 W 7TH ST
Second Line	:	SUITE 201
City	:	RENO
State	:	NV
Zip	:	89503-2700
Country	:	US
Telephone Number	:	775-337-6700
Fax Number	:	775-337-6770

Provider Business Practice Location Address
First Line	:	805 W 7TH ST
Second Line	:	SUITE 201
City	:	RENO
State	:	NV
Zip	:	89503-2700
Country	:	US
Telephone Number	:	775-337-6700
Fax Number	:	775-337-6770

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KAI D FUNKE
Credential	:	DDS
Telephone Number	:	775-337-6700

Provider Enumeration Date	:	12/12/2012
Last Update Date	:	12/12/2012

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