Provider Demographics
NPI:1750580965
Name:LORETTA J. GUNN
Entity type:Organization
Organization Name:LORETTA J. GUNN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER OF DENTAL PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-523-1245
Mailing Address - Street 1:911 HAL GREER BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3701
Mailing Address - Country:US
Mailing Address - Phone:304-523-1245
Mailing Address - Fax:304-523-0217
Practice Address - Street 1:911 HAL GREER BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3701
Practice Address - Country:US
Practice Address - Phone:304-523-1245
Practice Address - Fax:304-523-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty