Basic Information
| Provider Information | |||||||||
| NPI: | 1043374762 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNN | ||||||||
| FirstName: | MARTIN | ||||||||
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| Credential: | DMD OMS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3189 | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132203189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154546000 | ||||||||
| FaxNumber: | 3154548650 | ||||||||
| Practice Location | |||||||||
| Address1: | 1036 BRIGHTON AVE, | ||||||||
| Address2: | UNIT A | ||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077732150 | ||||||||
| FaxNumber: | 2077330220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0106X | 9474 | MA | N | Dental Providers | Dentist | Oral and Maxillofacial Pathology | 1223P0106X | 2168 | ME | Y | Dental Providers | Dentist | Oral and Maxillofacial Pathology | 1223P0106X | 3312 | NH | N | Dental Providers | Dentist | Oral and Maxillofacial Pathology | 1223P0106X | DEN02483 | RI | N | Dental Providers | Dentist | Oral and Maxillofacial Pathology |
No ID Information.