Provider Demographics
NPI:1205064987
Name:BUNIN, KEVIN MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:BUNIN
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 1:14 PIDGEON HILL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6133
Mailing Address - Country:US
Mailing Address - Phone:703-444-4104
Mailing Address - Fax:703-444-9344
Practice Address - Street 1:14 PIDGEON HILL DR STE 200
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6133
Practice Address - Country:US
Practice Address - Phone:703-444-4104
Practice Address - Fax:703-444-9344
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty