Provider Demographics
NPI:1679794432
Name:KUNCH, PAUL SCOT (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:SCOT
Last Name:KUNCH
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 1:1605 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627
Mailing Address - Country:US
Mailing Address - Phone:319-372-3390
Mailing Address - Fax:
Practice Address - Street 1:1605 AVENUE A
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627
Practice Address - Country:US
Practice Address - Phone:319-372-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA75211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice