Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 29184 | TX |
NPI | 1023450970 |
---|---|
Provider Name | Dr. John Clayton Tunnell |
First Address | Dallas, TX 75204-2190 |
Second Address | Dallas, TX 75204-2190 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2013 |
Last Update Date | 27/01/2022 |