Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 6106 | AZ |
Y | 1223D0001X | Dental Public Health | D10947 | OR |
NPI | 1558482133 |
---|---|
Provider Name | Joe Dunn |
First Address | Grants Pass, OR 97526-1051 |
Second Address | Grants Pass, OR 97526-1051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 05/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500758394 | (05) | OR |
883018 | (05) | AZ |