Provider Demographics
NPI:1326132069
Name:BUNTYN, LARRY ROSS JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ROSS
Last Name:BUNTYN
Suffix:JR
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 1:1203 GOVERNMENT ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3819
Mailing Address - Country:US
Mailing Address - Phone:228-875-3343
Mailing Address - Fax:228-872-9794
Practice Address - Street 1:1203 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3819
Practice Address - Country:US
Practice Address - Phone:228-875-3343
Practice Address - Fax:228-872-9794
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA56101223G0001X
MS3086-99122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice