Provider Demographics
NPI:1477024529
Name:STEVEN J. BUMGARNER, D.D.S. & JAMES P. MARTIN, D.M.D., M.S., P.A.
Entity Type:Organization
Organization Name:STEVEN J. BUMGARNER, D.D.S. & JAMES P. MARTIN, D.M.D., M.S., P.A.
Other - Org Name:BUMGARNER & MARTIN ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:919-495-8591
Mailing Address - Street 1:1268 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4997
Mailing Address - Country:US
Mailing Address - Phone:919-556-7820
Mailing Address - Fax:
Practice Address - Street 1:1268 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4997
Practice Address - Country:US
Practice Address - Phone:919-556-7820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty