Provider Demographics
NPI:1619037579
Name:DUNKLE, TODD R (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:R
Last Name:DUNKLE
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 1:6357 MONROE STREET
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1429
Mailing Address - Country:US
Mailing Address - Phone:419-882-8822
Mailing Address - Fax:419-882-8829
Practice Address - Street 1:6357 MONROE STREET
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-1429
Practice Address - Country:US
Practice Address - Phone:419-882-8822
Practice Address - Fax:419-882-8829
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0236917Medicaid