Healthcare Provider Details

I. General information

NPI: 1952816233
Provider Name (Legal Business Name): ALVIN BUNIAG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 07/25/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48TH MDG/RAF LAKENHEATH 5115
APO AE
09461
US

IV. Provider business mailing address

3750 COMMERCIAL AVE
SAN ANTONIO TX
78221-3117
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-9371
  • Fax:
Mailing address:
  • Phone: 210-922-7000
  • Fax: 210-637-2484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02938300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS043038
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number34938
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS102092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: