Provider Demographics
NPI:1851689913
Name:BUNKER, JARED BRENT (DMD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:BRENT
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 1:10175 RANCHO CARMEL DR
Mailing Address - Street 2:SUITE 126
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3675
Mailing Address - Country:US
Mailing Address - Phone:858-675-9055
Mailing Address - Fax:858-675-9040
Practice Address - Street 1:10175 RANCHO CARMEL DR
Practice Address - Street 2:SUITE 126
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3675
Practice Address - Country:US
Practice Address - Phone:858-675-9055
Practice Address - Fax:858-675-9040
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice