Provider Demographics
NPI:1740530781
Name:DUNN, SAMANTHA RAQUEL (RD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RAQUEL
Last Name:DUNN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:RAQUEL
Other - Last Name:TICKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5745 ADVENTURE DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3050
Mailing Address - Country:US
Mailing Address - Phone:614-563-6283
Mailing Address - Fax:
Practice Address - Street 1:5745 ADVENTURE DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3050
Practice Address - Country:US
Practice Address - Phone:614-563-6283
Practice Address - Fax:419-479-6005
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6915133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered