Provider Demographics
NPI:1134129927
Name:KUNKLE, TERRY LYNN II (DMD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LYNN
Last Name:KUNKLE
Suffix:II
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 1:119 LIBRARY ST
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3751
Mailing Address - Country:US
Mailing Address - Phone:843-761-8065
Mailing Address - Fax:843-761-5085
Practice Address - Street 1:119 LIBRARY ST
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3751
Practice Address - Country:US
Practice Address - Phone:843-761-8065
Practice Address - Fax:843-761-5085
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC3119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3119-0Medicaid