Provider Demographics
NPI:1417437567
Name:BUNDALO, ZORAN (DMD MS BSE (HON))
Entity Type:Individual
Prefix:DR
First Name:ZORAN
Middle Name:
Last Name:BUNDALO
Suffix:
Gender:M
Credentials:DMD MS BSE (HON)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 E BELL RD STE 115
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2237
Mailing Address - Country:US
Mailing Address - Phone:602-482-5100
Mailing Address - Fax:
Practice Address - Street 1:4045 E BELL RD STE 115
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2237
Practice Address - Country:US
Practice Address - Phone:602-482-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0101411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice