Provider Demographics
NPI:1578583407
Name:KUNKEL, DALE ALAN (DDS, FAGD, FICOI)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:ALAN
Last Name:KUNKEL
Suffix:
Gender:M
Credentials:DDS, FAGD, FICOI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 LA QUESTA DR
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-2833
Mailing Address - Country:US
Mailing Address - Phone:417-451-1566
Mailing Address - Fax:417-451-5262
Practice Address - Street 1:2040 LA QUESTA DR
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-2833
Practice Address - Country:US
Practice Address - Phone:417-451-1566
Practice Address - Fax:417-451-5262
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0141951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice