1720767247 NPI number — DAVID LOGAN DUNCAN DMD

Table of content: DAVID LOGAN DUNCAN DMD (NPI 1720767247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720767247 NPI number — DAVID LOGAN DUNCAN DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNCAN
Provider First Name:
DAVID
Provider Middle Name:
LOGAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720767247
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PYRAMID LAKE TRIBAL HEALTH CLINIC 705 HIGHWAY 446
Provider Second Line Business Mailing Address:
P.O. BOX 227
Provider Business Mailing Address City Name:
NIXON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-574-1018
Provider Business Mailing Address Fax Number:
775-574-1028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PYRAMID LAKE TRIBAL HEALTH CLINIC 705 HIGHWAY 446
Provider Second Line Business Practice Location Address:
P.O. BOX 227
Provider Business Practice Location Address City Name:
NIXON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-574-1018
Provider Business Practice Location Address Fax Number:
775-574-1028
Provider Enumeration Date:
07/12/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  8226 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8226 . This is a "LICENSE NUMBER" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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