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General NPI Number Information
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NPI Number | 1306301072
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Entity Type | Organization
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Legal Business Name | DR. LEE GUS DUNKER
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Dates
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Enumeration Date | 02/06/2019
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Last Update Date | 02/06/2019
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Provider Practice Location Address
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Address Line | 424 WEST ST
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City | MADISON
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State | IN
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Zip | 47250-3302
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Country | US
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Telephone | 812-265-2832
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Fax | 812-265-2832
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Provider Business Mailing Address
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Address Line | 424 WEST ST
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City | MADISON
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State | IN
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Zip | 47250-3302
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Country | US
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Telephone | 812-265-2832
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Fax | 812-265-2832
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SUE ANN DUNKER
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Credential |
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Telephone | 812-265-2832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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