Provider Demographics
NPI:1558745893
Name:TUNEBERG, KENT (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:
Last Name:TUNEBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 MORSAY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4851
Mailing Address - Country:US
Mailing Address - Phone:815-399-0866
Mailing Address - Fax:815-399-0895
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:815-399-0895
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190302221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice