Provider Demographics
NPI:1891884235
Name:KUNZ, GREGORY THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:THOMAS
Last Name:KUNZ
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 1:3707 N TWIN CITY HWY
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-2116
Mailing Address - Country:US
Mailing Address - Phone:409-962-9391
Mailing Address - Fax:409-962-3932
Practice Address - Street 1:3707 N. TWIN CITY HWY.
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-2116
Practice Address - Country:US
Practice Address - Phone:409-962-9391
Practice Address - Fax:409-962-3932
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4874122300000X
TX168501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01456691OtherUNITED CONCORDIA INDIV#
AZ429036Medicaid
1371004OtherUNITED CONCORDIA GP#
TX182745301Medicaid
54041OtherSAFEGUARD
AZAZ0475180OtherBCBS OF AZ
54038OtherSAFEGUARD
828432OtherUNITED CONCORDIA GP#