Individual provider Active NPI

Michael J Kunzler, DMD

  • Dentist
  • Lyman, WY
National Provider Identifier
1609938679
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
WY1116 Issued in WY
Practice address
37 Meadow Street
Suite C
Lyman, WY 82937
Phone
(307) 786-4500
Fax
(307) 786-4649
NPI assigned
Dec 15, 2006
Sex
Male
Sole proprietor
No

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
WY1116WYMDDentist

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X WY1116 WY Primary

Addresses

NPPES NPI Registry

Primary practice location

37 Meadow Street
Suite C
Lyman, WY 82937

Mailing address

37 Meadow Street
Suite C
Lyman, WY 82937
Phone (307) 786-4500

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
120147600MedicaidWY

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609938679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 MEADOW STREET",
            "address_2": "SUITE C",
            "city": "LYMAN",
            "state": "WY",
            "postal_code": "82937",
            "telephone_number": "307-786-4500",
            "fax_number": "307-786-4649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 MEADOW STREET",
            "address_2": "SUITE C",
            "city": "LYMAN",
            "state": "WY",
            "postal_code": "82937",
            "telephone_number": "307-786-4500",
            "fax_number": "307-786-4649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUNZLER",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WY",
            "license": "WY1116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120147600",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lyman, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.