Healthcare Provider Details

I. General information

NPI: 1902060445
Provider Name (Legal Business Name): JACQUELINE BUNCE DDS,MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 SE 38TH ST STE 225
BELLEVUE WA
98006-5232
US

IV. Provider business mailing address

PO BOX 5555
BELLEVUE WA
98006-0055
US

V. Phone/Fax

Practice location:
  • Phone: 425-401-2905
  • Fax:
Mailing address:
  • Phone: 425-401-2905
  • Fax: 425-401-1049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE00007620
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: