Provider Demographics
NPI:1376679068
Name:DUNN, LISA LEA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:LEA
Last Name:DUNN
Suffix:
Gender:F
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 747
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-0747
Mailing Address - Country:US
Mailing Address - Phone:304-263-5114
Mailing Address - Fax:
Practice Address - Street 1:2500 FOUNDATION WAY
Practice Address - Street 2:WVU HEALTH SCIENCES CENTER EASTERN DIVISION
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9000
Practice Address - Country:US
Practice Address - Phone:304-264-9202
Practice Address - Fax:304-264-9042
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist