Healthcare Provider Details

I. General information

NPI: 1497685531
Provider Name (Legal Business Name): PARKER JAY BUNDY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5475 DAVISON RD
BURTON MI
48509-1520
US

IV. Provider business mailing address

5475 DAVISON RD
BURTON MI
48509-1520
US

V. Phone/Fax

Practice location:
  • Phone: 810-202-9608
  • Fax:
Mailing address:
  • Phone: 810-202-9608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901603122
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: