Provider Demographics
NPI:1417209370
Name:DUNN DIABETES & WELLNESS CENTER, PA
Entity Type:Organization
Organization Name:DUNN DIABETES & WELLNESS CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DO, OD, MPH
Authorized Official - Phone:850-267-3498
Mailing Address - Street 1:141 MACK BAYOU LOOP
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-7156
Mailing Address - Country:US
Mailing Address - Phone:850-267-3498
Mailing Address - Fax:850-267-3421
Practice Address - Street 1:141 MACK BAYOU LOOP
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-7156
Practice Address - Country:US
Practice Address - Phone:850-267-3498
Practice Address - Fax:850-267-3421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10285261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty