Provider Demographics
NPI:1811404494
Name:BUNDY, CHET EDWARD (RDH)
Entity Type:Individual
Prefix:MR
First Name:CHET
Middle Name:EDWARD
Last Name:BUNDY
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N CROMWELL RD APT J7
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-3844
Mailing Address - Country:US
Mailing Address - Phone:912-657-1519
Mailing Address - Fax:
Practice Address - Street 1:1718 N COASTAL HWY
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:GA
Practice Address - Zip Code:31320-3415
Practice Address - Country:US
Practice Address - Phone:912-880-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH012531124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist