Provider Demographics
NPI:1194033423
Name:DUNHAM, ALFRED EUGENE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:EUGENE
Last Name:DUNHAM
Suffix:JR
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 1:1800 N 16TH ST
Mailing Address - Street 2:DUPLEX 1
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-1101
Mailing Address - Country:US
Mailing Address - Phone:712-438-4030
Mailing Address - Fax:
Practice Address - Street 1:1800 N 16TH ST
Practice Address - Street 2:DUPLEX 1
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-1101
Practice Address - Country:US
Practice Address - Phone:712-438-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA064211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice