MEDICARE: DMBUNNPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5496	NV

General Provider Information

NPI Number	:	1124395264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DMBUNNPC

Provider Business Mailing Address
First Line	:	7373 PEAK DR
Second Line	:	SUITE 130
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9003
Country	:	US
Telephone Number	:	702-870-2896
Fax Number	:	702-870-4981

Provider Business Practice Location Address
First Line	:	7373 PEAK DR
Second Line	:	SUITE 130
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9003
Country	:	US
Telephone Number	:	702-870-2896
Fax Number	:	702-870-4981

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIEL MITCHELL BUNN
Credential	:	D.D.S.
Telephone Number	:	702-530-3024

Provider Enumeration Date	:	11/17/2011
Last Update Date	:	11/17/2011

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Directions to “DMBUNNPC ” Practice Location

Language	Start Address	Practice Location

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