Provider Demographics
NPI:1891169843
Name:BUNNAG DENTAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:BUNNAG DENTAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:USA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNNAG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-681-2969
Mailing Address - Street 1:344 UNIVERSITY BLVD W STE 214
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1970
Mailing Address - Country:US
Mailing Address - Phone:301-681-2969
Mailing Address - Fax:301-681-0214
Practice Address - Street 1:11104 NEWPORT MILL RD
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1633
Practice Address - Country:US
Practice Address - Phone:301-942-9556
Practice Address - Fax:301-942-9556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD114941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty