Provider Demographics
NPI:1255476594
Name:DUNN, JON GREGORY (DMD)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:GREGORY
Last Name:DUNN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:110 BARRETT ST
Mailing Address - City:PROVIDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:42450
Mailing Address - Country:US
Mailing Address - Phone:270-667-7073
Mailing Address - Fax:270-667-7073
Practice Address - Street 1:110 BARRETT ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:KY
Practice Address - Zip Code:42450
Practice Address - Country:US
Practice Address - Phone:270-667-7073
Practice Address - Fax:270-667-7073
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY58931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice