Provider Demographics
NPI:1437112331
Name:DUNBAR, EDWARD ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ROBERT
Last Name:DUNBAR
Suffix:
Gender:M
Credentials:DDS
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 356
Mailing Address - Street 2:
Mailing Address - City:SHELL LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54871-0356
Mailing Address - Country:US
Mailing Address - Phone:715-468-2125
Mailing Address - Fax:715-468-2167
Practice Address - Street 1:600 EAST COUNTY HIGHWAY B
Practice Address - Street 2:
Practice Address - City:SHELL LAKE
Practice Address - State:WI
Practice Address - Zip Code:54871-0356
Practice Address - Country:US
Practice Address - Phone:715-468-2125
Practice Address - Fax:715-468-2167
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001675122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33353200Medicaid