Healthcare Provider Details

I. General information

NPI: 1841570850
Provider Name (Legal Business Name): THOMAS JUDSON DUNN D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N. MAIN ST. SUITE 140
SPRINGBORO OH
45066
US

IV. Provider business mailing address

825 N. MAIN ST. SUITE 140
SPRINGBORO OH
45066
US

V. Phone/Fax

Practice location:
  • Phone: 937-762-5000
  • Fax: 937-762-5099
Mailing address:
  • Phone: 937-762-5000
  • Fax: 937-762-5099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34010897
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: