Provider Demographics
NPI:1598810871
Name:KUNZLER, RICHARD CLARK (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CLARK
Last Name:KUNZLER
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 1:65 S 100 E
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-2600
Mailing Address - Country:US
Mailing Address - Phone:435-896-9393
Mailing Address - Fax:435-893-8742
Practice Address - Street 1:65 S 100 E
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-2600
Practice Address - Country:US
Practice Address - Phone:435-896-9393
Practice Address - Fax:435-893-8742
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT34182799221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice