MEDICARE: DR. THOMAS PATRICK DUNHAM DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7898	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BLUE CROSS BLUE SHIE	OTHER	VA	141303
2	UNITED CONCORDIA	OTHER	VA	808130
3	DELTA DENTAL	OTHER	VA	043365

General Provider Information

NPI Number	:	1508832445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS PATRICK DUNHAM DDS

Provider Business Mailing Address
First Line	:	2008 GENERAL BOOTH BLVD
Second Line	:	STE A
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5910
Country	:	US
Telephone Number	:	757-427-7130
Fax Number	:	757-427-7135

Provider Business Practice Location Address
First Line	:	2008 GENERAL BOOTH BLVD
Second Line	:	STE A
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5910
Country	:	US
Telephone Number	:	757-427-7130
Fax Number	:	757-427-7135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	07/08/2007

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