Provider Demographics
NPI:1407870538
Name:TAMBUNAN, DAVID Y (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:Y
Last Name:TAMBUNAN
Suffix:
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 1:8150 OAKLANDON RD
Mailing Address - Street 2:SUITE 128
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-9525
Mailing Address - Country:US
Mailing Address - Phone:317-826-8761
Mailing Address - Fax:317-826-8787
Practice Address - Street 1:8150 OAKLANDON RD
Practice Address - Street 2:SUITE 128
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-9525
Practice Address - Country:US
Practice Address - Phone:317-826-8761
Practice Address - Fax:317-826-8787
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120098871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice