Provider Demographics
NPI:1912134750
Name:DUNN, MIRANDA LEIGH (DDS)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:LEIGH
Last Name:DUNN
Suffix:
Gender:
Credentials:DDS
Other - Prefix:DR
Other - First Name:MIRANDA
Other - Middle Name:LEIGH
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3484 BUTCHER BEND RD
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:WV
Mailing Address - Zip Code:26150-3087
Mailing Address - Country:US
Mailing Address - Phone:304-514-1583
Mailing Address - Fax:
Practice Address - Street 1:1412 BLIZZARD DR
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-6458
Practice Address - Country:US
Practice Address - Phone:304-424-6100
Practice Address - Fax:304-424-5333
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD145031223G0001X
WV38621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810020766Medicaid