Healthcare Provider Details

I. General information

NPI: 1457555492
Provider Name (Legal Business Name): FIONA M NUNES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 WILLIAMS DR SUITE 111
GEORGETOWN TX
78628-3261
US

IV. Provider business mailing address

1500 W UNIVERSITY AVE SUITE 103
GEORGETOWN TX
78628-7108
US

V. Phone/Fax

Practice location:
  • Phone: 512-864-1445
  • Fax: 512-864-1447
Mailing address:
  • Phone: 512-868-1124
  • Fax: 512-868-9894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23086
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: