Provider Demographics
NPI:1760624266
Name:KUNTZ, ROBERT CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
Last Name:KUNTZ
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 1:777 S NEW BALLAS RD
Mailing Address - Street 2:315E
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8705
Mailing Address - Country:US
Mailing Address - Phone:314-569-2282
Mailing Address - Fax:314-569-2282
Practice Address - Street 1:777 S NEW BALLAS RD
Practice Address - Street 2:315E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8705
Practice Address - Country:US
Practice Address - Phone:314-569-2282
Practice Address - Fax:314-569-2282
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO11733122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist