Provider Demographics
NPI:1316013410
Name:GUNELSON, KRAIG DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRAIG
Middle Name:DAVID
Last Name:GUNELSON
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 1:1419 CLOQUET AVE
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1943
Mailing Address - Country:US
Mailing Address - Phone:218-879-3341
Mailing Address - Fax:218-879-3342
Practice Address - Street 1:1419 CLOQUET AVE
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1943
Practice Address - Country:US
Practice Address - Phone:218-879-3341
Practice Address - Fax:218-879-3342
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND113571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN153L3KROtherBCBS PROVIDER ID #