Provider Demographics
NPI:1982899134
Name:CELIA P. DUNN, D.M.D., P.C.
Entity Type:Organization
Organization Name:CELIA P. DUNN, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-650-9700
Mailing Address - Street 1:584 BLUE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3604
Mailing Address - Country:US
Mailing Address - Phone:706-650-9700
Mailing Address - Fax:706-650-0642
Practice Address - Street 1:584 BLUE RIDGE DR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3604
Practice Address - Country:US
Practice Address - Phone:706-650-9700
Practice Address - Fax:706-650-0642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0108901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
161756OtherUNITED CONCORDIA
GA00437302AMedicaid