Provider Demographics
NPI:1285083170
Name:DUNMIRE, ANNIKA ROSE
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:ROSE
Last Name:DUNMIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNIKA
Other - Middle Name:ROSE
Other - Last Name:MERISTU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:2240 WINROW RD
Mailing Address - Street 2:BLDG 45005
Mailing Address - City:FORT HUACHUCA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613-5080
Mailing Address - Country:US
Mailing Address - Phone:520-533-3147
Mailing Address - Fax:
Practice Address - Street 1:2240 WINROW RD
Practice Address - Street 2:BLDG 45505
Practice Address - City:FORT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613-5080
Practice Address - Country:US
Practice Address - Phone:520-533-3147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH01795124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist