Provider Demographics
NPI:1477799872
Name:DUNNER, JUSTIN IREY
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:IREY
Last Name:DUNNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-2658
Mailing Address - Country:US
Mailing Address - Phone:254-424-3408
Mailing Address - Fax:254-799-3902
Practice Address - Street 1:806 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-2658
Practice Address - Country:US
Practice Address - Phone:254-424-3408
Practice Address - Fax:254-799-3902
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities