Provider Demographics
NPI:1154555142
Name:KUNNEL, JESSIE (DDS)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:
Last Name:KUNNEL
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 1:9933 LAWLER AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3726
Mailing Address - Country:US
Mailing Address - Phone:847-675-5590
Mailing Address - Fax:
Practice Address - Street 1:9933 LAWLER AVE STE 401
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3726
Practice Address - Country:US
Practice Address - Phone:847-675-5590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190242931223X0400X
IL0190248361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics