Provider Demographics
NPI:1356517247
Name:PERRY K. TUNEBERG D.D.S. AND ASSOCIATES
Entity type:Organization
Organization Name:PERRY K. TUNEBERG D.D.S. AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:TUNEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-399-0866
Mailing Address - Street 1:4040 MORSAY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4899
Mailing Address - Country:US
Mailing Address - Phone:815-399-0866
Mailing Address - Fax:815-399-0895
Practice Address - Street 1:4040 MORSAY DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4899
Practice Address - Country:US
Practice Address - Phone:815-399-0866
Practice Address - Fax:815-399-0895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190184621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty