Healthcare Provider Details

I. General information

NPI: 1013996081
Provider Name (Legal Business Name): DANIEL DAVID DUNHAM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 38717 38TH STREET USA DENTAC
FT GORDON GA
30905-5660
US

IV. Provider business mailing address

BLDG 38717 38TH STREET USA DENTAC
FT GORDON GA
30905-5660
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-6927
  • Fax: 706-787-2082
Mailing address:
  • Phone: 706-787-6927
  • Fax: 706-787-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number016478
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: