Individual provider Active NPI

Dale Alan Kunkel, DDS, FAGD, FICOI

  • General Practice Dentistry
  • Neosho, MO
National Provider Identifier
1578583407
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
014195 Issued in MO
Practice address
2040 La Questa Dr
Neosho, MO 64850-2833
Phone
(417) 451-1566
Fax
(417) 451-5262
NPI assigned
Jul 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 014195 MO Primary

Addresses

Primary practice location

2040 La Questa Dr
Neosho, MO 64850-2833

Mailing address

2040 La Questa Dr
Neosho, MO 64850-2833
Phone (417) 451-1566

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160203002954 MO Order and Referring Only - DentistPractitioner - Dentist 2264736701

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
014195MOMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1578583407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 LA QUESTA DR",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648502833",
            "telephone_number": "417-451-1566",
            "fax_number": "417-451-5262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 LA QUESTA DR",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648502833",
            "telephone_number": "417-451-1566",
            "fax_number": "417-451-5262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUNKEL",
        "first_name": "DALE",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "DDS, FAGD, FICOI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "014195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Neosho, MO

Sources for this page

Verify at the official NPI Registry.