Provider Demographics
NPI:1922092832
Name:R.M. BUNTIN, DDS, PC
Entity Type:Organization
Organization Name:R.M. BUNTIN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MCCOLLUM
Authorized Official - Last Name:BUNTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:912-265-2675
Mailing Address - Street 1:2925 PLAYER ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4950
Mailing Address - Country:US
Mailing Address - Phone:912-265-2675
Mailing Address - Fax:912-265-2886
Practice Address - Street 1:2925 PLAYER ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4950
Practice Address - Country:US
Practice Address - Phone:912-265-2675
Practice Address - Fax:912-265-2886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7287122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty