Healthcare Provider Details

I. General information

NPI: 1124164215
Provider Name (Legal Business Name): GWENDOLYN F DUNN D.D.S.,M.S.,P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2406 GARRISON BLVD
BALTIMORE MD
21216-2222
US

IV. Provider business mailing address

2406 GARRISON BLVD
BALTIMORE MD
21216-2222
US

V. Phone/Fax

Practice location:
  • Phone: 410-542-9780
  • Fax: 410-542-9782
Mailing address:
  • Phone: 410-542-9780
  • Fax: 410-542-9782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number05123
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: