Provider Demographics
NPI:1821874504
Name:DUNN, BENJAMIN ANTHONY
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ANTHONY
Last Name:DUNN
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:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-0151
Mailing Address - Country:US
Mailing Address - Phone:918-322-1187
Mailing Address - Fax:
Practice Address - Street 1:1253 W 166TH ST N
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-3751
Practice Address - Country:US
Practice Address - Phone:918-322-1187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist