Healthcare Provider Details

I. General information

NPI: 1770203481
Provider Name (Legal Business Name): DUNLAP DENTAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 11/08/2023
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HOOSIER DR.
ANGOLA IN
46703
US

IV. Provider business mailing address

240 HOOSIER DR.
ANGOLA IN
46703
US

V. Phone/Fax

Practice location:
  • Phone: 260-624-3355
  • Fax: 260-667-9966
Mailing address:
  • Phone: 260-624-3355
  • Fax: 260-667-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PENELOPE LYNN DUNLAP
Title or Position: DENTIST
Credential: DDS
Phone: 260-624-3355