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NPI Code Detail

MEDICARE: ETHAN DUNN DMD

MEDICARE: ETHAN DUNN DMD
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
11223G0001XGeneral Practice Dentistry9968KY
21223G0001XGeneral Practice Dentistry12013920AIN

General Provider Information

NPI Number : 1790203974
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHAN DUNN DMD
Provider Business Mailing Address
First Line : 150 MCCAULEY RD
Second Line :
City : WILMORE
State : KY
Zip : 40390-9553
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2241 STATE ST
Second Line :
City : NEW ALBANY
State : IN
Zip : 47150-4948
Country : US
Telephone Number : 812-945-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2017
Last Update Date : 10/05/2022

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