Healthcare Provider Details

I. General information

NPI: 1922169432
Provider Name (Legal Business Name): STEVEN T BUNN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 S JEFFERSON ST
ROANOKE VA
24016-4703
US

IV. Provider business mailing address

1121 S JEFFERSON ST
ROANOKE VA
24016-4703
US

V. Phone/Fax

Practice location:
  • Phone: 540-685-0028
  • Fax: 540-248-4595
Mailing address:
  • Phone: 540-685-0028
  • Fax: 540-248-4595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401006432
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: