Healthcare Provider Details

I. General information

NPI: 1205844461
Provider Name (Legal Business Name): DANIEL A. DUNBAR, D.M.D., M.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 MANCHESTER RD STE 201
SAINT LOUIS MO
63144-2640
US

IV. Provider business mailing address

9225 MANCHESTER RD STE 201
SAINT LOUIS MO
63144-2640
US

V. Phone/Fax

Practice location:
  • Phone: 314-961-9225
  • Fax: 314-961-9339
Mailing address:
  • Phone: 314-961-9225
  • Fax: 314-961-9339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number15347
License Number StateMO

VIII. Authorized Official

Name: DR. DANIEL ALLAN DUNBAR
Title or Position: PRESIDENT
Credential: D.M.D., M.S.
Phone: 314-961-9225