Provider Demographics
NPI:1952698656
Name:BUNCH, SHERIDAN DAVIES (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHERIDAN
Middle Name:DAVIES
Last Name:BUNCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8606 VILLAGE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5506
Mailing Address - Country:US
Mailing Address - Phone:210-654-6882
Mailing Address - Fax:210-654-0036
Practice Address - Street 1:8606 VILLAGE DR
Practice Address - Street 2:SUITE B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5506
Practice Address - Country:US
Practice Address - Phone:210-654-6882
Practice Address - Fax:210-654-0036
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX270931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2818700Medicaid