Provider Demographics
NPI:1649415340
Name:DUNBAR AND CONNOLLY DDS
Entity Type:Organization
Organization Name:DUNBAR AND CONNOLLY DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-321-5965
Mailing Address - Street 1:9609 E INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE V
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-8603
Mailing Address - Country:US
Mailing Address - Phone:704-321-5965
Mailing Address - Fax:704-321-5966
Practice Address - Street 1:9609 E INDEPENDENCE BLVD
Practice Address - Street 2:SUITE V
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-8603
Practice Address - Country:US
Practice Address - Phone:704-321-5965
Practice Address - Fax:704-321-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902R9Medicaid