Provider Demographics
NPI:1346713765
Name:DUNIVIN, CODY M (LD)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:M
Last Name:DUNIVIN
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 COMMERCE AVE STE 309A
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3738
Mailing Address - Country:US
Mailing Address - Phone:360-232-8756
Mailing Address - Fax:
Practice Address - Street 1:1339 COMMERCE AVE STE 309A
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3738
Practice Address - Country:US
Practice Address - Phone:360-232-8756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN60869545122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist