Provider Demographics
NPI:1699818872
Name:BUNCH-PAYNE, ORAL AND MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:BUNCH-PAYNE, ORAL AND MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUNCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-951-6387
Mailing Address - Street 1:756 PORTER AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-4232
Mailing Address - Country:US
Mailing Address - Phone:209-951-6387
Mailing Address - Fax:209-951-2824
Practice Address - Street 1:756 PORTER AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-4232
Practice Address - Country:US
Practice Address - Phone:209-951-6387
Practice Address - Fax:209-951-2824
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUNCH-PAYNE ORAL AND MAXILLOFACIAL SURGERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-15
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD46419OtherDENTI-CAL DR PAYNE
CAD21974OtherDENTI-CAL DR BUNCH
CADK858ZOtherPTAN - FRED BUNCH DDS
CADK863ZOtherPTAN - JEFFREY PAYNE DDS
CADK845AOtherPTAN - BUNCH-PAYNE OMS
CAD46419OtherDENTI-CAL DR PAYNE
CADK863ZOtherPTAN - JEFFREY PAYNE DDS
CAT08286Medicare UPIN
CADK863ZMedicare PIN
CADK845AMedicare PIN