Healthcare Provider Details

I. General information

NPI: 1265539779
Provider Name (Legal Business Name): BRYAN C BUMPAS DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 W NOBLE AVE
GUTHRIE OK
73044
US

IV. Provider business mailing address

2121 W NOBLE AVE
GUTHRIE OK
73044
US

V. Phone/Fax

Practice location:
  • Phone: 405-282-6444
  • Fax: 405-282-6457
Mailing address:
  • Phone: 405-282-6444
  • Fax: 405-282-6457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYAN C BUMPAS
Title or Position: PRESIDENT
Credential: DDS
Phone: 405-282-6444