Provider Demographics
NPI:1053057257
Name:DUNHAM, NATHAN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:M
Last Name:DUNHAM
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 1:1041 11TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:THOMPSON
Mailing Address - State:ND
Mailing Address - Zip Code:58278-9349
Mailing Address - Country:US
Mailing Address - Phone:701-330-3797
Mailing Address - Fax:
Practice Address - Street 1:117 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-3450
Practice Address - Country:US
Practice Address - Phone:701-746-1481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program