Provider Demographics
NPI:1609938679
Name:KUNZLER, MICHAEL J (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:KUNZLER
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 1:37 MEADOW STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:LYMAN
Mailing Address - State:WY
Mailing Address - Zip Code:82937
Mailing Address - Country:US
Mailing Address - Phone:307-786-4500
Mailing Address - Fax:307-786-4649
Practice Address - Street 1:37 MEADOW STREET
Practice Address - Street 2:SUITE C
Practice Address - City:LYMAN
Practice Address - State:WY
Practice Address - Zip Code:82937
Practice Address - Country:US
Practice Address - Phone:307-786-4500
Practice Address - Fax:307-786-4649
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY1116122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY120147600Medicaid