MEDICARE: DR. KALEIGH MORGAN BUNDY DDS

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	122300000X	Dentist	7302	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7302	OTHER	LA	STATE LICENSE

General Provider Information

NPI Number	:	1437897659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KALEIGH MORGAN BUNDY DDS

Provider Business Mailing Address
First Line	:	234 PEREGRINE WAY
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-2556
Country	:	US
Telephone Number	:	318-464-0475
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 HOMER RD
Second Line	:
City	:	MINDEN
State	:	LA
Zip	:	71055-2732
Country	:	US
Telephone Number	:	318-377-9411
Fax Number	:

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

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	05/26/2022

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