Provider Demographics
NPI:1083062749
Name:BUNKERS, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BUNKERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 E ROUTE 66
Mailing Address - Street 2:STE. 107
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4694
Mailing Address - Country:US
Mailing Address - Phone:626-857-4702
Mailing Address - Fax:626-857-4703
Practice Address - Street 1:2220 E ROUTE 66
Practice Address - Street 2:SUITE 107
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4694
Practice Address - Country:US
Practice Address - Phone:626-857-4702
Practice Address - Fax:626-857-4703
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27592122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist