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General NPI Number Information
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NPI Number | 1669097143
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Entity Type | Individual
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Provider Name | KATHRYN DUNDERVILL DMD
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Gender | Female
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 7401 CREEDMOOR RD
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City | RALEIGH
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State | NC
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Zip | 27613-1640
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Country | US
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Telephone | 919-719-1780
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Fax |
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Provider Business Mailing Address
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Address Line | 511 N PERSON ST APT 107
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City | RALEIGH
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State | NC
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Zip | 27604-0007
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12624
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 0442000383
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12624
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License Number State | NC
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