Provider Demographics
NPI:1215156302
Name:KUNERT, RANDALL DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:DAVID
Last Name:KUNERT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 MESA VERDE DR E STE 105
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5221
Mailing Address - Country:US
Mailing Address - Phone:714-825-0025
Mailing Address - Fax:714-435-0831
Practice Address - Street 1:1525 MESA VERDE DR. EAST SUITE 105
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2506
Practice Address - Country:US
Practice Address - Phone:714-825-0025
Practice Address - Fax:714-835-0831
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADP0361681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice