Healthcare Provider Details

I. General information

NPI: 1417107418
Provider Name (Legal Business Name): DAVID R BUNDY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W CROSS DR SUITE #603
LITTLETON CO
80123-2239
US

IV. Provider business mailing address

9200 W CROSS DR SUITE #603
LITTLETON CO
80123-2239
US

V. Phone/Fax

Practice location:
  • Phone: 303-932-7458
  • Fax: 303-932-7460
Mailing address:
  • Phone: 303-932-7458
  • Fax: 303-932-7460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number10226
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: