Provider Demographics
NPI:1932545696
Name:DUNN FAMILY DENTAL
Entity Type:Organization
Organization Name:DUNN FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-753-3100
Mailing Address - Street 1:11723 MAUMELLE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6558
Mailing Address - Country:US
Mailing Address - Phone:501-753-3100
Mailing Address - Fax:501-753-4505
Practice Address - Street 1:11723 MAUMELLE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-6558
Practice Address - Country:US
Practice Address - Phone:501-753-3100
Practice Address - Fax:501-753-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3642122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR196815631Medicaid