Provider Demographics
NPI:1467561357
Name:NUNN, ROBERT W (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:NUNN
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 1:3050 S NATIONAL AVE
Mailing Address - Street 2:SUITE # 105
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4247
Mailing Address - Country:US
Mailing Address - Phone:417-887-8801
Mailing Address - Fax:417-881-0105
Practice Address - Street 1:3050 S NATIONAL AVE
Practice Address - Street 2:SUITE # 105
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4247
Practice Address - Country:US
Practice Address - Phone:417-887-8801
Practice Address - Fax:417-881-0105
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0149081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice