Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 018.002190 | IL |
NPI | 1437728326 |
---|---|
Provider Name | Dr. Kyle Allan Dunn |
First Address | Champaign, IL 61822-3555 |
Second Address | Urbana, IL 61801-2530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2021 |
Last Update Date | 23/06/2021 |