David Scott Dunivan, D.M.D.,M.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

021-002115 Issued in IL

Practice address

1120 S State Route 157 Ste 102
Edwardsville, IL 62025-3614

Phone

(618) 655-1580

Fax

(618) 655-1581

NPI assigned

Nov 21, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Interoperability endpoints

• Direct secure messaging: davidscott.dunivan.p1@direct.affiniahealthcare.nextgenshare.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306911003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 S STATE ROUTE 157 STE 102",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620253614",
            "telephone_number": "618-655-1580",
            "fax_number": "618-655-1581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 S STATE ROUTE 157 STE 102",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620253614",
            "telephone_number": "618-655-1580",
            "fax_number": "618-655-1581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUNIVAN",
        "first_name": "DAVID",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "D.M.D.,M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "021-002115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• April Douglas
• Joshua Wayne Dowdy, DC
• Keidron Nicole Duckwitz, RN
• Teri Dudley, DNP, RN, NE-BC
• Katelyn Duniphan
• Rebecca Lynn Dunn, D.M.D.
• Cheyenne Renee Durham, OT
• Carolyn Jean Duvall, LCSW
• Jaime Sue Dwiggins
• Kelsey L Dyer, RBT

• Periodontics in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.