Provider Demographics
NPI:1437116605
Name:BUNCE, BRIAN LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LEE
Last Name:BUNCE
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 1:225 2ND ST N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5058
Mailing Address - Country:US
Mailing Address - Phone:651-439-4945
Mailing Address - Fax:651-439-4945
Practice Address - Street 1:225 2ND ST N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5058
Practice Address - Country:US
Practice Address - Phone:651-439-4945
Practice Address - Fax:651-439-4945
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-29
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND82061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice