Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 003550 | SC |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 3550 | SC |
NPI | 1982622585 |
---|---|
Provider Name | Dr. Derek T Dunlap |
First Address | Duncan, SC 29334 |
Second Address | Duncan, SC 29334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 23/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ZX3550 | (05) | SC |