Provider Demographics
NPI:1265643316
Name:DUNLAP DENTAL SERVICES, P.C.
Entity Type:Organization
Organization Name:DUNLAP DENTAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-875-6595
Mailing Address - Street 1:3700 E MISHAWAKA RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517-3550
Mailing Address - Country:US
Mailing Address - Phone:574-875-6595
Mailing Address - Fax:
Practice Address - Street 1:3700 E MISHAWAKA RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-3550
Practice Address - Country:US
Practice Address - Phone:574-875-6595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN54001077A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty