Provider Demographics
NPI:1184718108
Name:BUNCZAK REEH, MARY ANN J (DDS MS)
Entity type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:J
Last Name:BUNCZAK REEH
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:MARY ANN
Other - Middle Name:J
Other - Last Name:BUNCZAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS MS
Mailing Address - Street 1:2600 WILD PINES LANE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5420
Mailing Address - Country:US
Mailing Address - Phone:651-439-8085
Mailing Address - Fax:651-439-9705
Practice Address - Street 1:2600 WILD PINES LANE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5420
Practice Address - Country:US
Practice Address - Phone:651-439-8085
Practice Address - Fax:651-439-9705
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND107101223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics