Provider Demographics
NPI:1184086597
Name:BUNDY FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:BUNDY FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:BUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-521-3560
Mailing Address - Street 1:155 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68003-1504
Mailing Address - Country:US
Mailing Address - Phone:402-521-3560
Mailing Address - Fax:
Practice Address - Street 1:155 N 24TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:NE
Practice Address - Zip Code:68003-1504
Practice Address - Country:US
Practice Address - Phone:402-521-3560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7082335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier