Provider Demographics
NPI:1912002114
Name:BUNT, BENJAMIN EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:EDWARD
Last Name:BUNT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 QUAIL STREET
Mailing Address - Street 2:
Mailing Address - City:VAN
Mailing Address - State:TX
Mailing Address - Zip Code:75790-3841
Mailing Address - Country:US
Mailing Address - Phone:903-963-8681
Mailing Address - Fax:903-963-8681
Practice Address - Street 1:299 QUAIL STREET
Practice Address - Street 2:
Practice Address - City:VAN
Practice Address - State:TX
Practice Address - Zip Code:75790-3841
Practice Address - Country:US
Practice Address - Phone:903-963-8681
Practice Address - Fax:903-963-8681
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20154122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist