Provider Demographics
NPI:1376724823
Name:DUNN, LARRICE MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:LARRICE
Middle Name:MICHELLE
Last Name:DUNN
Suffix:
Gender:F
Credentials:
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 1317
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75570-1317
Mailing Address - Country:US
Mailing Address - Phone:903-628-1360
Mailing Address - Fax:903-628-1361
Practice Address - Street 1:103 NE FRONT ST
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570-2906
Practice Address - Country:US
Practice Address - Phone:903-628-1360
Practice Address - Fax:903-628-1361
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier