Provider Demographics
NPI:1730663352
Name:DENTAL CHOICE OF MELBOURNE LLC
Entity Type:Organization
Organization Name:DENTAL CHOICE OF MELBOURNE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IOULIA
Authorized Official - Middle Name:YUMA
Authorized Official - Last Name:BUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-410-3540
Mailing Address - Street 1:3983 CHEDINGTON LN
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6915
Mailing Address - Country:US
Mailing Address - Phone:609-410-3540
Mailing Address - Fax:
Practice Address - Street 1:402 N BABCOCK ST STE 103
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-7335
Practice Address - Country:US
Practice Address - Phone:321-600-4487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental