Provider Demographics
NPI:1124077961
Name:DUNN, PAUL CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CHARLES
Last Name:DUNN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-4525
Mailing Address - Country:US
Mailing Address - Phone:806-894-3535
Mailing Address - Fax:806-894-7468
Practice Address - Street 1:701 8TH ST
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-4525
Practice Address - Country:US
Practice Address - Phone:806-894-3535
Practice Address - Fax:806-894-7468
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008166301Medicaid