Provider Demographics
NPI:1528232691
Name:GARY L KUENNING DDS
Entity Type:Organization
Organization Name:GARY L KUENNING DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KUENNING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-622-0145
Mailing Address - Street 1:5021 S FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6968
Mailing Address - Country:US
Mailing Address - Phone:918-622-0145
Mailing Address - Fax:918-627-4850
Practice Address - Street 1:5021 S FULTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6968
Practice Address - Country:US
Practice Address - Phone:918-622-0145
Practice Address - Fax:918-627-4850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4169261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental