Healthcare Provider Details

I. General information

NPI: 1588297279
Provider Name (Legal Business Name): DENNIS M DUNNE DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 EXECUTIVE PKWY STE 350
EUGENE OR
97401-7110
US

IV. Provider business mailing address

1600 EXECUTIVE PKWY STE 350
EUGENE OR
97401-7110
US

V. Phone/Fax

Practice location:
  • Phone: 541-485-0175
  • Fax: 541-344-5129
Mailing address:
  • Phone: 541-485-0175
  • Fax: 541-344-5129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier240580
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: ANNIE BRADELY
Title or Position: OFFICE MANAGER
Credential:
Phone: 541-485-0175