Healthcare Provider Details

I. General information

NPI: 1942089032
Provider Name (Legal Business Name): CHRISTY DUNHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2258 W ROOSEVELT BLVD STE B
MONROE NC
28110-3090
US

IV. Provider business mailing address

969 COBBLESTONE LN
TARPON SPRINGS FL
34688-9218
US

V. Phone/Fax

Practice location:
  • Phone: 727-409-2950
  • Fax:
Mailing address:
  • Phone: 727-409-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN26242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: