Provider Demographics
NPI:1306992482
Name:KUNJUMON, AGEE V (DMD)
Entity type:Individual
Prefix:DR
First Name:AGEE
Middle Name:V
Last Name:KUNJUMON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 WINDY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2610
Mailing Address - Country:US
Mailing Address - Phone:210-391-5710
Mailing Address - Fax:
Practice Address - Street 1:11339 HUGHES RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-4637
Practice Address - Country:US
Practice Address - Phone:281-481-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice