Provider Demographics
NPI:1063457026
Name:KUNKEL, RAY J (DMD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:J
Last Name:KUNKEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05663-5745
Mailing Address - Country:US
Mailing Address - Phone:802-485-3051
Mailing Address - Fax:802-485-8384
Practice Address - Street 1:391 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:VT
Practice Address - Zip Code:05663-5745
Practice Address - Country:US
Practice Address - Phone:802-485-3051
Practice Address - Fax:802-485-8384
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT9981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0002761Medicaid