Provider Demographics
NPI:1104995539
Name:KUNSTMANN, VIVIAN ROSE (DDS)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:ROSE
Last Name:KUNSTMANN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9291 GLADES ROAD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434
Mailing Address - Country:US
Mailing Address - Phone:561-470-8006
Mailing Address - Fax:561-470-8007
Practice Address - Street 1:9291 GLADES ROAD
Practice Address - Street 2:SUITE 304
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434
Practice Address - Country:US
Practice Address - Phone:561-470-8006
Practice Address - Fax:561-470-8007
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist