Provider Demographics
NPI:1649485541
Name:PETER G. KUENZLI, D.D.S., P.C.
Entity type:Organization
Organization Name:PETER G. KUENZLI, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:GILLEN
Authorized Official - Last Name:KUENZLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-490-9300
Mailing Address - Street 1:3637 KINGS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4604
Mailing Address - Country:US
Mailing Address - Phone:757-486-2119
Mailing Address - Fax:
Practice Address - Street 1:4876 PRINCESS ANNE RD
Practice Address - Street 2:SUITE #111
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4447
Practice Address - Country:US
Practice Address - Phone:757-490-9300
Practice Address - Fax:757-490-9871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007122261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental