Provider Demographics
NPI:1164505764
Name:DUNLAP, JAMES BRYAN (DDSPA,)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRYAN
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:DDSPA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 ALDERSGATE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6611
Mailing Address - Country:US
Mailing Address - Phone:501-975-1539
Mailing Address - Fax:501-224-9900
Practice Address - Street 1:1515 ALDERSGATE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6611
Practice Address - Country:US
Practice Address - Phone:501-975-1539
Practice Address - Fax:501-224-9900
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3265122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR710833717OtherTAX ID #
AR5U157OtherBLUE CROSS BLUE SHIELD
AR978863OtherUNITED CONCORDIA