Provider Demographics
NPI:1053532796
Name:DUNHAM, MICHAEL ROY (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROY
Last Name:DUNHAM
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 1:3701 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:TX
Mailing Address - Zip Code:79549-4630
Mailing Address - Country:US
Mailing Address - Phone:325-573-4115
Mailing Address - Fax:
Practice Address - Street 1:3701 AVENUE U
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:TX
Practice Address - Zip Code:79549-4630
Practice Address - Country:US
Practice Address - Phone:325-573-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice