Healthcare Provider Details

I. General information

NPI: 1972424026
Provider Name (Legal Business Name): DORIAN DUNHAM PLADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E 5TH ST
FREMONT NE
68025-5163
US

IV. Provider business mailing address

15040 GILES RD APT 101
OMAHA NE
68138-3678
US

V. Phone/Fax

Practice location:
  • Phone: 402-917-2570
  • Fax:
Mailing address:
  • Phone: 402-830-5675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP-2443
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: