Provider Demographics
NPI:1164535621
Name:BUNN, ELDON LEON (DDS)
Entity Type:Individual
Prefix:
First Name:ELDON
Middle Name:LEON
Last Name:BUNN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8305 CR44 LEG-A
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3706
Mailing Address - Country:US
Mailing Address - Phone:352-728-4066
Mailing Address - Fax:352-728-2816
Practice Address - Street 1:8305 CR44 LEG-A
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3706
Practice Address - Country:US
Practice Address - Phone:352-728-4066
Practice Address - Fax:352-728-2816
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN7086122300000X
NE4620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist