Provider Demographics
NPI:1639245087
Name:KUENZLI, PETER GILLEN (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:GILLEN
Last Name:KUENZLI
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 1:4876 PRINCESS ANNE RD STE 111
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4447
Mailing Address - Country:US
Mailing Address - Phone:757-490-9300
Mailing Address - Fax:757-490-9871
Practice Address - Street 1:4876 PRINCESS ANNE RD STE 111
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4447
Practice Address - Country:US
Practice Address - Phone:757-490-9300
Practice Address - Fax:757-490-9871
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007122122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist