Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 254090 | MS |
NPI | 1003920489 |
---|---|
Provider Name | Mr. Frederic Bertrand Dunn |
First Address | Gulfport, MS 39502 |
Second Address | Gulfport, MS 39501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 08/07/2007 |