Healthcare Provider Details

I. General information

NPI: 1578723292
Provider Name (Legal Business Name): DANIEL ALLAN DUNBAR D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
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 ROAD STE. 201
ST. LOUIS MO
63144
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:
Title or Position:
Credential:
Phone: