Healthcare Provider Details

I. General information

NPI: 1063111599
Provider Name (Legal Business Name): ELLEN PATRICIA DUNAJCIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 ANN ST
NEWPORT KY
41071-1337
US

IV. Provider business mailing address

830 ANN ST
NEWPORT KY
41071-1337
US

V. Phone/Fax

Practice location:
  • Phone: 859-415-3633
  • Fax:
Mailing address:
  • Phone: 859-415-3633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: