Provider Demographics
NPI:1801992623
Name:BUNEL, KIRBY L (DDS)
Entity type:Individual
Prefix:DR
First Name:KIRBY
Middle Name:L
Last Name:BUNEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 MOORES LN
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-1894
Mailing Address - Country:US
Mailing Address - Phone:903-794-3331
Mailing Address - Fax:903-793-7217
Practice Address - Street 1:1701 MOORES LN
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1894
Practice Address - Country:US
Practice Address - Phone:903-794-3331
Practice Address - Fax:903-793-7217
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX157741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX49891Medicare UPIN