Provider Demographics
NPI:1932416997
Name:KUNSEMILLER, JEFF
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:KUNSEMILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 THOUVENOT LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7203
Mailing Address - Country:US
Mailing Address - Phone:618-206-8040
Mailing Address - Fax:618-206-8082
Practice Address - Street 1:1219 THOUVENOT LN
Practice Address - Street 2:SUITE 103
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-7203
Practice Address - Country:US
Practice Address - Phone:618-206-8040
Practice Address - Fax:618-206-8082
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0021301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics