Provider Demographics
NPI:1174718878
Name:DUNN, RICHARD E (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:DUNN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W TULARE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4811
Mailing Address - Country:US
Mailing Address - Phone:559-625-3030
Mailing Address - Fax:559-625-4015
Practice Address - Street 1:101 W TULARE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4811
Practice Address - Country:US
Practice Address - Phone:559-625-3030
Practice Address - Fax:559-625-4015
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301811122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACGP165926Medicaid
CAB301811Medicaid