Healthcare Provider Details

I. General information

NPI: 1043363443
Provider Name (Legal Business Name): TEDDRICK LOVELL DUNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 N MACARTHUR BLVD STE 107
IRVING TX
75038-6497
US

IV. Provider business mailing address

4301 N MACARTHUR BLVD STE 107
IRVING TX
75038-6497
US

V. Phone/Fax

Practice location:
  • Phone: 469-351-3432
  • Fax: 469-333-8025
Mailing address:
  • Phone: 469-351-3432
  • Fax: 469-333-8025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberQ6623
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: