Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 014924 | MO |
NPI | 1073610622 |
---|---|
Provider Name | Aurelia A Dunagan |
First Address | Chesterfield, MO 63017-5735 |
Second Address | Chesterfield, MO 63017-5735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 08/07/2007 |