Provider Demographics
NPI:1366556391
Name:DUNN, PHILLIP REX (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:REX
Last Name:DUNN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 NORTHRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2040
Mailing Address - Country:US
Mailing Address - Phone:505-326-2007
Mailing Address - Fax:505-326-2007
Practice Address - Street 1:708 E 20TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4205
Practice Address - Country:US
Practice Address - Phone:505-327-6155
Practice Address - Fax:505-327-6156
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM13461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice