Provider Demographics
NPI:1518179514
Name:DUNEKACK, TATUM (DDS)
Entity Type:Individual
Prefix:DR
First Name:TATUM
Middle Name:
Last Name:DUNEKACK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-2453
Mailing Address - Country:US
Mailing Address - Phone:620-792-7690
Mailing Address - Fax:620-792-7719
Practice Address - Street 1:2124 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-2453
Practice Address - Country:US
Practice Address - Phone:620-792-7690
Practice Address - Fax:620-792-7719
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS600961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice