Provider Demographics
NPI:1902013550
Name:SAN DIMAS DENTAL GROUP
Entity Type:Organization
Organization Name:SAN DIMAS DENTAL GROUP
Other - Org Name:JOHN P. BUNKERS, LARRY LIPKOWSKI, SADHANA SAVANI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BUNKERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-857-4702
Mailing Address - Street 1:2220 E ROUTE 66 STE 107
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-7600
Mailing Address - Country:US
Mailing Address - Phone:626-857-4702
Mailing Address - Fax:626-857-4703
Practice Address - Street 1:2220 E ROUTE 66 STE 107
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-7600
Practice Address - Country:US
Practice Address - Phone:626-857-4702
Practice Address - Fax:626-857-4703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA275921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty