Healthcare Provider Details

I. General information

NPI: 1295045565
Provider Name (Legal Business Name): MARY ANN DUNN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 RIO VISTA DR. C/O FTHC - DENTAL
FALLON NV
89406
US

IV. Provider business mailing address

1001 RIO VISTA DR. C/O FTHC - DENTAL
FALLON NV
89406
US

V. Phone/Fax

Practice location:
  • Phone: 775-423-3634
  • Fax: 775-423-4342
Mailing address:
  • Phone: 775-423-3634
  • Fax: 775-423-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number101144
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: