Provider Demographics
NPI:1194734277
Name:BUNDY, CRAIG EMBERTSON (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:EMBERTSON
Last Name:BUNDY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 HAMILTON ROAD
Mailing Address - Street 2:DENTAC
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-0000
Mailing Address - Country:US
Mailing Address - Phone:580-442-5518
Mailing Address - Fax:
Practice Address - Street 1:652 HAMILTON ROAD
Practice Address - Street 2:DENTAC
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-0000
Practice Address - Country:US
Practice Address - Phone:580-442-5518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT16751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice