Provider Demographics
NPI:1922014802
Name:TUNZI, JACK VICTOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:VICTOR
Last Name:TUNZI
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 1:500 E OLIVE AVE
Mailing Address - Street 2:#660
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-3316
Mailing Address - Country:US
Mailing Address - Phone:818-567-0100
Mailing Address - Fax:818-567-0200
Practice Address - Street 1:5OO E. OLIVE AVE
Practice Address - Street 2:#660
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501
Practice Address - Country:US
Practice Address - Phone:818-567-0100
Practice Address - Fax:818-567-0200
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA401991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA40199Medicare UPIN