MEDICARE: DR. STANLEY CHARLES BUNSICK D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	MO D12484	MO

General Provider Information

NPI Number	:	1285796169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANLEY CHARLES BUNSICK D.D.S.

Provider Business Mailing Address
First Line	:	106 4 SEASONS SHOPPING CTR
Second Line	:	SUITE108
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3173
Country	:	US
Telephone Number	:	314-469-0964
Fax Number	:	314-469-6080

Provider Business Practice Location Address
First Line	:	106 4 SEASONS SHOPPING CTR
Second Line	:	SUITE108
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3173
Country	:	US
Telephone Number	:	314-469-0964
Fax Number	:	314-469-6080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. STANLEY CHARLES BUNSICK D.D.S.” Practice Location

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