Healthcare Provider Details

I. General information

NPI: 1295022341
Provider Name (Legal Business Name): ROBERT DANIEL DUNAVANT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1059 BARTON DR
FORDLAND MO
65652-7350
US

IV. Provider business mailing address

1059 BARTON DR
FORDLAND MO
65652-7350
US

V. Phone/Fax

Practice location:
  • Phone: 417-767-2100
  • Fax:
Mailing address:
  • Phone: 417-767-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2019020350
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: