Provider Demographics
NPI:1265743934
Name:DAVID M. BUNKALL, D.D.S., M.S., P.A.
Entity type:Organization
Organization Name:DAVID M. BUNKALL, D.D.S., M.S., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BUNKALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:620-227-2234
Mailing Address - Street 1:705 1ST AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-4437
Mailing Address - Country:US
Mailing Address - Phone:620-227-2234
Mailing Address - Fax:620-227-8084
Practice Address - Street 1:705 1ST AVE STE B
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-4437
Practice Address - Country:US
Practice Address - Phone:620-227-2234
Practice Address - Fax:620-227-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60750261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental