MEDICARE: LYNNE A DUNHAM DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4226	OK

General Provider Information

NPI Number	:	1740356617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNNE A DUNHAM DDS PC

Provider Business Mailing Address
First Line	:	6001 NW 120TH COURT
Second Line	:	SUITE 1
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-1700
Country	:	US
Telephone Number	:	405-722-0841
Fax Number	:

Provider Business Practice Location Address
First Line	:	6001 NW 120TH COURT
Second Line	:	SUITE 1
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-1700
Country	:	US
Telephone Number	:	405-722-0841
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LYNNE A DUNHAM
Credential	:	DDS
Telephone Number	:	405-722-0841

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	03/18/2014

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