Provider Demographics
NPI:1053384925
Name:DUNCKEL, GARY (DDS)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:DUNCKEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-1745
Mailing Address - Country:US
Mailing Address - Phone:303-857-4388
Mailing Address - Fax:303-857-1179
Practice Address - Street 1:6075 E PARKWAY DR
Practice Address - Street 2:SUITE 160
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-5400
Practice Address - Country:US
Practice Address - Phone:303-286-8900
Practice Address - Fax:303-286-8260
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02005668Medicaid