Provider Demographics
NPI:1356888416
Name:KUNKEL, HEIDI J (DMD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:J
Last Name:KUNKEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6958 NEBRASKA AVE
Mailing Address - Street 2:1608
Mailing Address - City:FT LEONARD WD
Mailing Address - State:MO
Mailing Address - Zip Code:65473-1618
Mailing Address - Country:US
Mailing Address - Phone:573-596-0411
Mailing Address - Fax:573-596-0410
Practice Address - Street 1:6958 NEBRASKA AVE
Practice Address - Street 2:1608
Practice Address - City:FT LEONARD WD
Practice Address - State:MO
Practice Address - Zip Code:65473-1618
Practice Address - Country:US
Practice Address - Phone:573-596-0411
Practice Address - Fax:573-596-0410
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0127751122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist