Healthcare Provider Details

I. General information

NPI: 1285770768
Provider Name (Legal Business Name): DANIEL WALLACE NUNLEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 EAST MAIN STREET
WHITE SULPHUR SPRINGS WV
24986
US

IV. Provider business mailing address

304 EAST MAIN STREET PO BOX 399
WHITE SULPHUR SPRINGS WV
24986
US

V. Phone/Fax

Practice location:
  • Phone: 304-536-3304
  • Fax: 304-536-3308
Mailing address:
  • Phone: 304-536-3304
  • Fax: 304-536-3308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2128
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: