Provider Demographics
NPI:1073699542
Name:CHUNN, MARK W (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:CHUNN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:WHITE
Other - Middle Name:RIVER
Other - Last Name:DENTAL CENTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:259 EAGLE MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-4232
Mailing Address - Country:US
Mailing Address - Phone:870-698-0900
Mailing Address - Fax:870-698-0332
Practice Address - Street 1:259 EAGLE MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-4232
Practice Address - Country:US
Practice Address - Phone:870-698-0900
Practice Address - Fax:870-698-0332
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR30781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR3078Medicaid
AR260994631Medicaid