Provider Demographics
NPI:1972773265
Name:JOHN P. BUNNELL D.D.S. INC.
Entity Type:Organization
Organization Name:JOHN P. BUNNELL D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BUNNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-322-9357
Mailing Address - Street 1:79-7592 MAMALAHOA HWY
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-7908
Mailing Address - Country:US
Mailing Address - Phone:808-322-9357
Mailing Address - Fax:808-322-0921
Practice Address - Street 1:79-7592 MAMALAHOA HWY
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-7908
Practice Address - Country:US
Practice Address - Phone:808-322-9357
Practice Address - Fax:808-322-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT19381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty