Provider Demographics
NPI:1033408950
Name:DR. GWENDOLYN DUNN D.D.S, M.S. P.A
Entity Type:Organization
Organization Name:DR. GWENDOLYN DUNN D.D.S, M.S. P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-542-9780
Mailing Address - Street 1:2406 GARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-2222
Mailing Address - Country:US
Mailing Address - Phone:410-542-9780
Mailing Address - Fax:410-542-0211
Practice Address - Street 1:2406 GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2222
Practice Address - Country:US
Practice Address - Phone:410-542-9780
Practice Address - Fax:410-542-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD951044364Medicaid