Provider Demographics
NPI:1104593532
Name:DUNLAP, CHIWON (RDH)
Entity type:Individual
Prefix:MRS
First Name:CHIWON
Middle Name:
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 NE MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-3606
Mailing Address - Country:US
Mailing Address - Phone:253-222-3156
Mailing Address - Fax:
Practice Address - Street 1:2612 NE MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-3606
Practice Address - Country:US
Practice Address - Phone:253-222-3156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00006204124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist