Provider Demographics
NPI:1639749898
Name:MICHAEL E KUN DMD PC
Entity Type:Organization
Organization Name:MICHAEL E KUN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KUN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-266-9048
Mailing Address - Street 1:881 3RD ST STE A2
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-5922
Mailing Address - Country:US
Mailing Address - Phone:610-266-9048
Mailing Address - Fax:610-266-0250
Practice Address - Street 1:881 3RD ST STE A2
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-5922
Practice Address - Country:US
Practice Address - Phone:610-266-9048
Practice Address - Fax:610-266-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS027849LOtherLICENSE #