Provider Demographics
NPI:1215228333
Name:BEVERLEY J BUNN D.D.S., M.D.S., P.A.
Entity Type:Organization
Organization Name:BEVERLEY J BUNN D.D.S., M.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-433-7777
Mailing Address - Street 1:1912 VICTORIA CIR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2320
Mailing Address - Country:US
Mailing Address - Phone:806-433-7777
Mailing Address - Fax:469-247-1151
Practice Address - Street 1:7230 BRIAR PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1600
Practice Address - Country:US
Practice Address - Phone:210-921-9191
Practice Address - Fax:210-921-2408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-23
Last Update Date:2011-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty