Provider Demographics
NPI:1326211145
Name:DUNLAP, KIM R (RDH, BS)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:R
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:DUNLAP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH, BS
Mailing Address - Street 1:303 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-2901
Mailing Address - Country:US
Mailing Address - Phone:406-799-3876
Mailing Address - Fax:
Practice Address - Street 1:303 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-2901
Practice Address - Country:US
Practice Address - Phone:406-799-3876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-13
Last Update Date:2008-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1060124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist