Provider Demographics
NPI:1982056867
Name:BUNASSAR, JENEVIEVE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENEVIEVE
Middle Name:
Last Name:BUNASSAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 SW 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4311
Mailing Address - Country:US
Mailing Address - Phone:954-974-2140
Mailing Address - Fax:954-974-5204
Practice Address - Street 1:1239 SW 26TH AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4311
Practice Address - Country:US
Practice Address - Phone:954-974-2140
Practice Address - Fax:954-974-5204
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21997122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist