Healthcare Provider Details

I. General information

NPI: 1770657322
Provider Name (Legal Business Name): TROY BUNYON SLUDER III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 CYPRESS LANE, UNIT C
MANTEO NC
27954
US

IV. Provider business mailing address

PO BOX 490 503 CYPRESS LANE, UNIT C
MANTEO NC
27954-0490
US

V. Phone/Fax

Practice location:
  • Phone: 252-475-9841
  • Fax: 252-475-9843
Mailing address:
  • Phone: 252-475-9841
  • Fax: 252-475-9843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5847
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: