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General NPI Number Information
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NPI Number | 1710259908
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Entity Type | Individual
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Provider Name | MICHAEL JAMES BUNDY D.M.D., M.D., PHARM.
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Gender | Male
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 10833 LE CONTE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90095-3075
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Country | US
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Telephone | 310-825-3241
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Fax |
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Provider Business Mailing Address
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Address Line | 12222 WILSHIRE BLVD APT 407
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City | LOS ANGELES
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State | CA
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Zip | 90025-1165
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Country | US
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Telephone | 302-399-6554
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 58849
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License Number State | CA
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