Provider Demographics
NPI:1326464249
Name:CHEMUNG FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:CHEMUNG FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:607-734-2045
Mailing Address - Street 1:1007 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14904-2503
Mailing Address - Country:US
Mailing Address - Phone:607-734-2045
Mailing Address - Fax:607-734-6103
Practice Address - Street 1:1007 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14904-2503
Practice Address - Country:US
Practice Address - Phone:607-734-2045
Practice Address - Fax:607-734-6103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYD041523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty