Provider Demographics
NPI:1740295518
Name:KUNNEL, JOSEPH G (DDS, MS, PHD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:KUNNEL
Suffix:
Gender:M
Credentials:DDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4105 FRONTAGE RD
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-1115
Mailing Address - Country:US
Mailing Address - Phone:815-223-0204
Mailing Address - Fax:815-223-0957
Practice Address - Street 1:4105 FRONTAGE RD
Practice Address - Street 2:SUITE 100A
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-1115
Practice Address - Country:US
Practice Address - Phone:815-223-0204
Practice Address - Fax:815-223-0957
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0242931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics