Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 2168 | ME |
N | 1223P0106X | Oral and Maxillofacial Pathology | 3312 | NH |
N | 1223P0106X | Oral and Maxillofacial Pathology | 9474 | MA |
N | 1223P0106X | Oral and Maxillofacial Pathology | DEN02483 | RI |
NPI | 1043374762 |
---|---|
Provider Name | Martin Dunn |
First Address | Syracuse, NY 13220-3189 |
Second Address | Portland, ME 04102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 08/07/2007 |