Provider Demographics
NPI:1225194319
Name:KUNSTMAN, ANDREW THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:THOMAS
Last Name:KUNSTMAN
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 1:1989 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4698
Mailing Address - Country:US
Mailing Address - Phone:520-458-5611
Mailing Address - Fax:520-458-8995
Practice Address - Street 1:1989 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4698
Practice Address - Country:US
Practice Address - Phone:520-458-5611
Practice Address - Fax:520-458-8995
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ39961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ094582Medicaid
AZ631015OtherUNITED CONCORDIA PROVIDER