Provider Demographics
NPI:1952457863
Name:KUNZ, NEIL L (DMD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:L
Last Name:KUNZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:305 EAST 5TH NORTH
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:ID
Mailing Address - Zip Code:83445-0567
Mailing Address - Country:US
Mailing Address - Phone:208-624-3757
Mailing Address - Fax:
Practice Address - Street 1:305 E 5TH N
Practice Address - Street 2:
Practice Address - City:SAINT ANTHONY
Practice Address - State:ID
Practice Address - Zip Code:83445-1626
Practice Address - Country:US
Practice Address - Phone:208-624-3757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-13971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice