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General NPI Number Information
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NPI Number | 1538541438
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Entity Type | Individual
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Provider Name | TIMOTHY BUNNELL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 1116 N CHINOWTH ST
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City | VISALIA
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State | CA
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Zip | 93291-7896
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Country | US
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Telephone | 559-732-7946
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Fax |
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Provider Business Mailing Address
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Address Line | 1116 N CHINOWTH ST
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City | VISALIA
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State | CA
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Zip | 93291-7896
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 103178
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 103178
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License Number State | CA
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