Provider Demographics
NPI:1164539482
Name:DUNCKER, MICHAEL C (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:DUNCKER
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 1:8500 FLORENCE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-4015
Mailing Address - Country:US
Mailing Address - Phone:562-923-4538
Mailing Address - Fax:562-622-1167
Practice Address - Street 1:8500 FLORENCE AVE STE 100
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-4015
Practice Address - Country:US
Practice Address - Phone:562-923-4538
Practice Address - Fax:562-622-1167
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice