Provider Demographics
NPI:1487925988
Name:ANDREW T. KUNSTMAN D.D.S. PC
Entity type:Organization
Organization Name:ANDREW T. KUNSTMAN D.D.S. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KUNSTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-458-5611
Mailing Address - Street 1:1989 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4698
Mailing Address - Country:US
Mailing Address - Phone:520-458-5611
Mailing Address - Fax:520-458-8995
Practice Address - Street 1:1989 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4698
Practice Address - Country:US
Practice Address - Phone:520-458-5611
Practice Address - Fax:520-458-8995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0039961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ631015OtherUNITED CONCORDIA
AZ094582Medicaid