Provider Demographics
NPI:1225256944
Name:BUNDY, MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:BUNDY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 TUCKAHOE RD
Mailing Address - Street 2:SUITE 380
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3844
Mailing Address - Country:US
Mailing Address - Phone:856-422-5200
Mailing Address - Fax:856-319-7435
Practice Address - Street 1:141 TUCKAHOE RD
Practice Address - Street 2:SUITE 380
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-3844
Practice Address - Country:US
Practice Address - Phone:856-422-5200
Practice Address - Fax:856-319-7435
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ227611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice