Provider Demographics
NPI:1124395264
Name:DMBUNNPC
Entity Type:Organization
Organization Name:DMBUNNPC
Other - Org Name:PEAK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:BUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-530-3024
Mailing Address - Street 1:7373 PEAK DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-9003
Mailing Address - Country:US
Mailing Address - Phone:702-870-2896
Mailing Address - Fax:702-870-4981
Practice Address - Street 1:7373 PEAK DR
Practice Address - Street 2:SUITE 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9003
Practice Address - Country:US
Practice Address - Phone:702-870-2896
Practice Address - Fax:702-870-4981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5496122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty