Provider Demographics
NPI:1295000156
Name:KUNKLE, TIMOTHY COOPER (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:COOPER
Last Name:KUNKLE
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5550 FRIENDSHIP BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-7296
Mailing Address - Country:US
Mailing Address - Phone:301-652-8555
Mailing Address - Fax:301-215-7578
Practice Address - Street 1:5550 FRIENDSHIP BLVD STE 250
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-7296
Practice Address - Country:US
Practice Address - Phone:301-652-8555
Practice Address - Fax:301-215-7578
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10018361223S0112X
MD163001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery