Provider Demographics
NPI:1558429654
Name:TUNEBERG, PERRY KENT (DDS)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:KENT
Last Name:TUNEBERG
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 1:3761 FOX POINTE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-7072
Mailing Address - Country:US
Mailing Address - Phone:815-633-2367
Mailing Address - Fax:
Practice Address - Street 1:4040 MORSAY DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4851
Practice Address - Country:US
Practice Address - Phone:815-399-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190184621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice