Provider Demographics
NPI:1285049387
Name:KUNZ, MATTHEW F (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:F
Last Name:KUNZ
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 1:180 S. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SODA SPRINGS
Mailing Address - State:ID
Mailing Address - Zip Code:83276
Mailing Address - Country:US
Mailing Address - Phone:208-547-2244
Mailing Address - Fax:208-547-0375
Practice Address - Street 1:180 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:SODA SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83276
Practice Address - Country:US
Practice Address - Phone:208-547-2244
Practice Address - Fax:208-547-0375
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-46181223G0001X
KS60969122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist