Provider Demographics
NPI:1043525488
Name:TUNISON, MICHELLE K (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:K
Last Name:TUNISON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:KUNTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:139 N JENSEN RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850
Mailing Address - Country:US
Mailing Address - Phone:607-754-3903
Mailing Address - Fax:607-748-4181
Practice Address - Street 1:139 N JENSEN RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850
Practice Address - Country:US
Practice Address - Phone:607-754-3903
Practice Address - Fax:607-748-4181
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05503211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry