MEDICARE: PETER G. KUENZLI, D.D.S., P.C.

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	0401007122	VA

General Provider Information

NPI Number	:	1649485541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER G. KUENZLI, D.D.S., P.C.

Provider Business Mailing Address
First Line	:	3637 KINGS LAKE DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-4604
Country	:	US
Telephone Number	:	757-486-2119
Fax Number	:

Provider Business Practice Location Address
First Line	:	4876 PRINCESS ANNE RD
Second Line	:	SUITE #111
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4447
Country	:	US
Telephone Number	:	757-490-9300
Fax Number	:	757-490-9871

Authorized Official
Title or Position	:	PRESIDENT OF CORPORATION
Name	:	DR. PETER GILLEN KUENZLI
Credential	:	DDS
Telephone Number	:	757-490-9300

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/22/2020

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