Provider Demographics
NPI:1821161001
Name:KUNKEL, JEFFREY R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:R
Last Name:KUNKEL
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 1:7525 N CEDAR AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2689
Mailing Address - Country:US
Mailing Address - Phone:559-439-6600
Mailing Address - Fax:559-439-5400
Practice Address - Street 1:7525 N CEDAR AVE STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2689
Practice Address - Country:US
Practice Address - Phone:559-439-6600
Practice Address - Fax:559-439-5400
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000105811223G0001X
CA600831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice