Provider Demographics
NPI:1821173006
Name:JUNTUNEN DENTAL LLC
Entity Type:Organization
Organization Name:JUNTUNEN DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:JUNTUNEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-336-9002
Mailing Address - Street 1:115 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DEPERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-1399
Mailing Address - Country:US
Mailing Address - Phone:920-336-9002
Mailing Address - Fax:920-336-8304
Practice Address - Street 1:115 S 8TH ST
Practice Address - Street 2:
Practice Address - City:DEPERE
Practice Address - State:WI
Practice Address - Zip Code:54115-1399
Practice Address - Country:US
Practice Address - Phone:920-336-9002
Practice Address - Fax:920-336-8304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty