1053384925 NPI number — GARY DUNCKEL 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 1053384925 NPI number — GARY DUNCKEL DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNCKEL
Provider First Name:
GARY
Provider Middle Name:
Provider Name Prefix Text:
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:
1053384925
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:
1115 2ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LUPTON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80621-1745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-857-4388
Provider Business Mailing Address Fax Number:
303-857-1179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6075 E PARKWAY DR
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
COMMERCE CITY
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80022-5400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-286-8900
Provider Business Practice Location Address Fax Number:
303-286-8260
Provider Enumeration Date:
02/09/2006

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:  566 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02005668 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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