Healthcare Provider Details

I. General information

NPI: 1053087270
Provider Name (Legal Business Name): DANESA NUNEZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 US HIGHWAY 380 STE 100
CROSSROADS TX
76227-8329
US

IV. Provider business mailing address

8332 EDGEPOINT TRL
HURST TX
76053-7447
US

V. Phone/Fax

Practice location:
  • Phone: 940-205-4293
  • Fax:
Mailing address:
  • Phone: 817-262-7565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number37777
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: