Provider Demographics
NPI:1073662227
Name:BUNTON DENTAL OFFICE
Entity Type:Organization
Organization Name:BUNTON DENTAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GARRETT
Authorized Official - Last Name:BUNTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-753-2664
Mailing Address - Street 1:4635 WYANDOTTE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1509
Mailing Address - Country:US
Mailing Address - Phone:816-753-2664
Mailing Address - Fax:816-753-4240
Practice Address - Street 1:4635 WYANDOTTE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1509
Practice Address - Country:US
Practice Address - Phone:816-753-2664
Practice Address - Fax:816-753-4240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO122551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty