MEDICARE: DR. WILLIAM JACKSON DUNN 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	15142	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	832626855	OTHER	TX	TAX ID
2	1952496465	OTHER	TX	NPI

General Provider Information

NPI Number	:	1952496465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM JACKSON DUNN DDS

Provider Business Mailing Address
First Line	:	81 DS/SGD
Second Line	:	606 FISHER STREET
City	:	KEESLER AFB
State	:	MS
Zip	:	39534
Country	:	US
Telephone Number	:	228-377-3003
Fax Number	:	228-377-7092

Provider Business Practice Location Address
First Line	:	238 N LOOP 1604 W STE 201
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-1455
Country	:	US
Telephone Number	:	210-465-7075
Fax Number	:	210-855-6933

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	11/22/2019

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