Provider Demographics
NPI:1265668248
Name:KUNZ, KRISTA MICHELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:MICHELLE
Last Name:KUNZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 N HIGHWAY 17 STE 103
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9300
Mailing Address - Country:US
Mailing Address - Phone:843-996-6796
Mailing Address - Fax:
Practice Address - Street 1:3070 N HIGHWAY 17 STE 103
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-9300
Practice Address - Country:US
Practice Address - Phone:843-996-6796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86101223P0221X
IDD-42881223G0001X
NMDD35491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM27101754Medicaid
NM1265668248OtherDENTAQUEST