Provider Demographics
NPI:1003830464
Name:JUNKER, KELLI (DDS)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:JUNKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NEWPORT CENTER #708
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8604
Mailing Address - Country:US
Mailing Address - Phone:949-640-2970
Mailing Address - Fax:949-640-2838
Practice Address - Street 1:400 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 708
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7601
Practice Address - Country:US
Practice Address - Phone:949-640-2970
Practice Address - Fax:949-640-2838
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA511601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice