Provider Demographics
NPI:1992823934
Name:DUNN, REBECCA LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LYNN
Last Name:DUNN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:DUNN
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:618 SAINT LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-1504
Mailing Address - Country:US
Mailing Address - Phone:618-692-6414
Mailing Address - Fax:618-656-8311
Practice Address - Street 1:618 SAINT LOUIS ST
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1504
Practice Address - Country:US
Practice Address - Phone:618-692-6414
Practice Address - Fax:618-656-8311
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist