Provider Demographics
NPI:1003963075
Name:DUNAVIN, BRENT WADE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:WADE
Last Name:DUNAVIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-0488
Mailing Address - Country:US
Mailing Address - Phone:479-996-4181
Mailing Address - Fax:
Practice Address - Street 1:7 W CENTER STREET
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936
Practice Address - Country:US
Practice Address - Phone:479-996-4181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice