Robert Daniel Dunavant, DDS
Individual provider Active NPI Dentist · Fordland, MO
NPI 1295022341 · NPPES record last updated Mar 2, 2020
Key facts
- NPI
- 1295022341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2019020350 (MO)
- Practice address
- 1059 Barton Dr
Fordland, MO 65652-7350 - Phone
- (417) 767-2100
- NPI assigned
- Jul 8, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160908001273 | TN | Order and Referring Only - Other (Non-Physician) | 1951697580 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019020350 | MO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. D'S Family Dentistry, LLC | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2019020350 | MO | Yes |
Addresses
Primary practice location
1059 Barton Dr
Fordland, MO 65652-7350
Mailing address
1059 Barton Dr
Fordland, MO 65652-7350
Phone (417) 767-2100
Other providers in Fordland, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.