Provider Demographics
NPI:1619548732
Name:DUNAWAY, ERIC STEPHEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:STEPHEN
Last Name:DUNAWAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 BRIDGE WATER LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2833
Mailing Address - Country:US
Mailing Address - Phone:720-345-8413
Mailing Address - Fax:
Practice Address - Street 1:104 SPANISH OAKS TRL
Practice Address - Street 2:
Practice Address - City:GLEN ROSE
Practice Address - State:TX
Practice Address - Zip Code:76043-4104
Practice Address - Country:US
Practice Address - Phone:254-897-3143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty