Provider Demographics
NPI:1588297279
Name:DENNIS M DUNNE DDS PC
Entity type:Organization
Organization Name:DENNIS M DUNNE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-485-0175
Mailing Address - Street 1:1600 EXECUTIVE PKWY STE 350
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7110
Mailing Address - Country:US
Mailing Address - Phone:541-485-0175
Mailing Address - Fax:541-344-5129
Practice Address - Street 1:1600 EXECUTIVE PKWY STE 350
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7110
Practice Address - Country:US
Practice Address - Phone:541-485-0175
Practice Address - Fax:541-344-5129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240580Medicaid