1427171446 NPI number — DR. KEVIN L KUNARD DDS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427171446 NPI number — DR. KEVIN L KUNARD DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUNARD
Provider First Name:
KEVIN
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427171446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 FREMONT LAKE RD
Provider Second Line Business Mailing Address:
P O BOX 803
Provider Business Mailing Address City Name:
PINEDALE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-367-3700
Provider Business Mailing Address Fax Number:
307-367-3701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 FREMONT LAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINEDALE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-367-3700
Provider Business Practice Location Address Fax Number:
307-367-3701
Provider Enumeration Date:
04/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  WY1036 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)