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General NPI Number Information
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NPI Number | 1215228333
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Entity Type | Organization
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Legal Business Name | BEVERLEY J BUNN D.D.S., M.D.S., P.A.
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Dates
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Enumeration Date | 04/23/2011
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Last Update Date | 04/23/2011
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Provider Practice Location Address
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Address Line | 7230 BRIAR PL
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City | SAN ANTONIO
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State | TX
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Zip | 78221-1600
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Country | US
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Telephone | 210-921-9191
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Fax | 210-921-2408
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Provider Business Mailing Address
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Address Line | 1912 VICTORIA CIR
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City | MCKINNEY
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State | TX
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Zip | 75070-2320
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Country | US
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Telephone | 806-433-7777
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Fax | 469-247-1151
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Authorized Official
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Title or Position | ORTHODONTIST/PRESIDENT
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Name | DR. BEVERLEY J BUNN
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Credential |
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Telephone | 806-433-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 19653
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License Number State | TX
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