Provider Demographics
NPI:1609934496
Name:KUNZE WERNER, ROMEO ADOLFO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROMEO
Middle Name:ADOLFO
Last Name:KUNZE WERNER
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 1:13909 AMAR ROAD
Mailing Address - Street 2:SUITE#E
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91746-1669
Mailing Address - Country:US
Mailing Address - Phone:626-856-1700
Mailing Address - Fax:
Practice Address - Street 1:13909 AMAR ROAD
Practice Address - Street 2:SUITE#E
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91746-1669
Practice Address - Country:US
Practice Address - Phone:626-856-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA417471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4174701Medicare UPIN