Provider Demographics
NPI:1932202264
Name:DUNCKLEE, ANDREW D (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:D
Last Name:DUNCKLEE
Suffix:
Gender:M
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 248
Mailing Address - Street 2:
Mailing Address - City:DRAYTON
Mailing Address - State:ND
Mailing Address - Zip Code:58225-0248
Mailing Address - Country:US
Mailing Address - Phone:701-454-6119
Mailing Address - Fax:
Practice Address - Street 1:110 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:DRAYTON
Practice Address - State:ND
Practice Address - Zip Code:58225
Practice Address - Country:US
Practice Address - Phone:701-454-6218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1469122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist