Individual
BLAKE KUNIMOTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3124 MONTVALE DR, SPRINGFIELD, IL 62704-6937
(217) 546-8777
Mailing address
3807 WEXFORD DR, SPRINGFIELD, IL 62704-6715
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019025927
IL
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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