Provider Demographics
NPI:1073504171
Name:DUNN, PAUL RANDOLPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RANDOLPH
Last Name:DUNN
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 1:8436 GREENARBOR RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2600
Mailing Address - Country:US
Mailing Address - Phone:505-238-9602
Mailing Address - Fax:
Practice Address - Street 1:2116 HINKLE ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-4930
Practice Address - Country:US
Practice Address - Phone:505-843-7493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD18121223G0001X
TX149231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0084916Medicaid