Provider Demographics
NPI:1184758443
Name:KUNKEL, ANN K (DDS)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:K
Last Name:KUNKEL
Suffix:
Gender:F
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:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-0399
Mailing Address - Country:US
Mailing Address - Phone:585-624-5886
Mailing Address - Fax:585-624-7395
Practice Address - Street 1:30 ASSEMBLY DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MENDON
Practice Address - State:NY
Practice Address - Zip Code:14506
Practice Address - Country:US
Practice Address - Phone:585-624-5886
Practice Address - Fax:585-624-3795
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY420601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01143282Medicaid
NY7564OtherBLUE CROSS BLUE SHIELD