Provider Demographics
NPI:1447369616
Name:DUNAWAY, ROBERT ADRIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ADRIAN
Last Name:DUNAWAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 CUMBERLAND AVE
Mailing Address - Street 2:PO BOX 96
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906
Mailing Address - Country:US
Mailing Address - Phone:606-546-3660
Mailing Address - Fax:606-546-4660
Practice Address - Street 1:240 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1204
Practice Address - Country:US
Practice Address - Phone:606-546-3660
Practice Address - Fax:606-546-4660
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY64301223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6430OtherLICENSE #
KY60064300Medicaid