Healthcare Provider Details

I. General information

NPI: 1053750893
Provider Name (Legal Business Name): ALLAN WUN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KNEELAND ST. 5TH FLOOR/ DHS 503
BOSTON MA
02111
US

IV. Provider business mailing address

10193 W. WESLEY PL
LAKEWOOD CO
80227
US

V. Phone/Fax

Practice location:
  • Phone: 303-885-6024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN1856291
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: