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General NPI Number Information
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NPI Number | 1386016749
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Entity Type | Organization
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Legal Business Name | L. RANDY BUNTYN, D.M.D. , PLLC
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Dates
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Enumeration Date | 10/26/2015
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 1203 GOVERNMENT ST.
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564
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Country | US
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Telephone | 228-875-3343
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Fax | 228-872-9794
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Provider Business Mailing Address
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Address Line | 1203 GOVERNMENT ST.
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564
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Country | US
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Telephone | 228-875-3343
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Fax | 228-872-9794
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Authorized Official
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Title or Position | PRESIDENT/MANAGER
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Name | LARRY ROSS BUNTYN JR.
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Credential | D.M.D.
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Telephone | 228-875-3343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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