Provider Demographics
NPI:1235730888
Name:BUNTON, DENNIS ALLEN
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:ALLEN
Last Name:BUNTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 BRECKENRIDGE ST STE 4
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1385
Mailing Address - Country:US
Mailing Address - Phone:270-215-4000
Mailing Address - Fax:270-215-4011
Practice Address - Street 1:2707 BRECKENRIDGE ST STE 4
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1385
Practice Address - Country:US
Practice Address - Phone:270-215-4000
Practice Address - Fax:270-215-4011
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional