Provider Demographics
NPI:1760833768
Name:NUNNELEE, NATHAN (DMD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:NUNNELEE
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 1:1023 OXMOOR RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5317
Mailing Address - Country:US
Mailing Address - Phone:205-438-7122
Mailing Address - Fax:
Practice Address - Street 1:1023 OXMOOR RD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-5317
Practice Address - Country:US
Practice Address - Phone:205-438-7122
Practice Address - Fax:205-438-7123
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3881-16122300000X
ALD-0006738-C11223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist