Provider Demographics
NPI:1114012952
Name:FUNKE, KAI D (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAI
Middle Name:D
Last Name:FUNKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 W 7TH ST
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-2705
Mailing Address - Country:US
Mailing Address - Phone:775-337-6700
Mailing Address - Fax:775-337-6770
Practice Address - Street 1:805 W 7TH ST
Practice Address - Street 2:SUITE # 201
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-2705
Practice Address - Country:US
Practice Address - Phone:775-337-6700
Practice Address - Fax:775-337-6770
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist