Provider Demographics
NPI:1922262682
Name:DUNLAP, MICHAEL ANDRE' (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANDRE'
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 E 103RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-2807
Mailing Address - Country:US
Mailing Address - Phone:773-468-4554
Mailing Address - Fax:773-468-4848
Practice Address - Street 1:255 E 103RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2807
Practice Address - Country:US
Practice Address - Phone:773-468-4554
Practice Address - Fax:773-468-4848
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019023067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist