Provider Demographics
NPI:1841570850
Name:DUNN, THOMAS JUDSON (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JUDSON
Last Name:DUNN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 N. MAIN ST.
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066
Mailing Address - Country:US
Mailing Address - Phone:937-762-5000
Mailing Address - Fax:937-762-5099
Practice Address - Street 1:825 N. MAIN ST.
Practice Address - Street 2:SUITE 140
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066
Practice Address - Country:US
Practice Address - Phone:937-762-5000
Practice Address - Fax:937-762-5099
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34010897207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0096531Medicaid
OH0096531Medicaid
OHH275754Medicare PIN