Provider Demographics
NPI:1275540619
Name:KUNZMAN, DAVID GORDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GORDON
Last Name:KUNZMAN
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 1:411 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2311
Mailing Address - Country:US
Mailing Address - Phone:910-592-3516
Mailing Address - Fax:910-592-0530
Practice Address - Street 1:411 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2311
Practice Address - Country:US
Practice Address - Phone:910-592-3516
Practice Address - Fax:910-592-0530
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC48571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8995078Medicaid