Provider Demographics
NPI:1396045845
Name:TODD D. FLERE D.D.S. AND WILLIAM T. KUNKEL, JR., D.D.S., INC.
Entity Type:Organization
Organization Name:TODD D. FLERE D.D.S. AND WILLIAM T. KUNKEL, JR., D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLERE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-759-8425
Mailing Address - Street 1:1041 E LIBERTY ST
Mailing Address - Street 2:P. O. BOX 430
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-2407
Mailing Address - Country:US
Mailing Address - Phone:330-759-8425
Mailing Address - Fax:330-759-8425
Practice Address - Street 1:1041 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-2407
Practice Address - Country:US
Practice Address - Phone:330-759-8425
Practice Address - Fax:330-759-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15772122300000X
OH21681122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty