Provider Demographics
NPI:1225051816
Name:BUNNELL, GEORGE ELWIN JR (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ELWIN
Last Name:BUNNELL
Suffix:JR
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 1:9 W EL ROSE DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-4022
Mailing Address - Country:US
Mailing Address - Phone:707-762-7381
Mailing Address - Fax:707-762-1582
Practice Address - Street 1:9 W EL ROSE DR
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-4022
Practice Address - Country:US
Practice Address - Phone:707-762-7381
Practice Address - Fax:707-762-1582
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19481122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist