Healthcare Provider Details

I. General information

NPI: 1841323821
Provider Name (Legal Business Name): WALTER N. BUMB D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 E SNYDER AVE
MONTPELIER OH
43543-1276
US

IV. Provider business mailing address

904 E SNYDER AVE
MONTPELIER OH
43543-1276
US

V. Phone/Fax

Practice location:
  • Phone: 419-485-4605
  • Fax: 419-485-8463
Mailing address:
  • Phone: 419-485-4605
  • Fax: 419-485-8463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30012417
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: