Provider Demographics
NPI:1508126731
Name:KELLI JUNKER DDS INC
Entity Type:Organization
Organization Name:KELLI JUNKER DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-420-0546
Mailing Address - Street 1:400 NEWPORT CENTER DRIVE #708
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8604
Mailing Address - Country:US
Mailing Address - Phone:949-640-2970
Mailing Address - Fax:
Practice Address - Street 1:400 NEWPORT CENTER DRIVE #708
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8604
Practice Address - Country:US
Practice Address - Phone:949-640-2970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51160261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental