Healthcare Provider Details

I. General information

NPI: 1699150128
Provider Name (Legal Business Name): DAVID R BUNDY DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 01/08/2016
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 Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License NumberDEN10226
License Number StateCO

VIII. Authorized Official

Name: DR. DAVID R. BUNDY
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 303-932-7458