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General NPI Number Information
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NPI Number | 1982925905
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Entity Type | Organization
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Legal Business Name | BUNCH-GORMAN, LLC
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Dates
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Enumeration Date | 06/14/2010
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Last Update Date | 06/14/2010
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Provider Practice Location Address
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Address Line | 1926 S DIXON RD
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City | KOKOMO
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State | IN
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Zip | 46902-7302
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Country | US
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Telephone | 765-459-3145
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Fax | 765-459-4048
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Provider Business Mailing Address
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Address Line | 1926 S DIXON RD
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City | KOKOMO
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State | IN
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Zip | 46902-7302
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Country | US
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Telephone | 765-459-3145
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Fax | 765-459-4048
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Authorized Official
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Title or Position | ORTHODONTIST/ CO-OWNER
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Name | JASON K BUNCH
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Credential | D.D.S., M.S.
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Telephone | 765-459-3145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 8906IN
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 12010651A
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License Number State | IN
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