Provider Demographics
NPI:1104491521
Name:JOSHUA M. VAN DER BUNT, DMD, LLC
Entity type:Organization
Organization Name:JOSHUA M. VAN DER BUNT, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DER BUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-249-8066
Mailing Address - Street 1:61054 SE MARBLE MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9386
Mailing Address - Country:US
Mailing Address - Phone:954-249-8066
Mailing Address - Fax:
Practice Address - Street 1:2127 S HIGHWAY 97 STE 210
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2656
Practice Address - Country:US
Practice Address - Phone:954-249-8066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental