Healthcare Provider Details

I. General information

NPI: 1760823983
Provider Name (Legal Business Name): WILLIAM MAURICE BUNCH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 EAST AMERICAN AVE.
ORACLE AZ
85623-0290
US

IV. Provider business mailing address

PO BOX 290
ORACLE AZ
85623-0290
US

V. Phone/Fax

Practice location:
  • Phone: 520-896-9334
  • Fax:
Mailing address:
  • Phone: 520-896-9334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1683
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1134291065
Identifier TypeOTHER
Identifier StateAZ
Identifier IssuerNPI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: