Provider Demographics
NPI:1750660577
Name:BUNKER, ADAM EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:EDWARD
Last Name:BUNKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82155
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89180-2155
Mailing Address - Country:US
Mailing Address - Phone:702-580-3155
Mailing Address - Fax:
Practice Address - Street 1:1923 MARSHA SHARP FWY
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-4036
Practice Address - Country:US
Practice Address - Phone:806-797-1094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX273271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice