Provider Demographics
NPI:1457555492
Name:NUNES, FIONA M
Entity type:Individual
Prefix:
First Name:FIONA
Middle Name:M
Last Name:NUNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-7108
Mailing Address - Country:US
Mailing Address - Phone:512-868-1124
Mailing Address - Fax:512-868-9894
Practice Address - Street 1:2411 WILLIAMS DR
Practice Address - Street 2:SUITE 111
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3261
Practice Address - Country:US
Practice Address - Phone:512-864-1445
Practice Address - Fax:512-864-1447
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191198401Medicaid
TX191198401Medicaid