Provider Demographics
NPI:1053327593
Name:BUNTING, LUCINDA K (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUCINDA
Middle Name:K
Last Name:BUNTING
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 WEST LIBERTY WAY
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963
Mailing Address - Country:US
Mailing Address - Phone:302-424-7976
Mailing Address - Fax:302-424-2324
Practice Address - Street 1:215 WEST LIBERTY WAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19563
Practice Address - Country:US
Practice Address - Phone:302-424-7976
Practice Address - Fax:302-424-2324
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1023122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000023496Medicaid
DE0000908808Medicaid
728083OtherUNITED CONCORDIA PROVIDER