Provider Demographics
NPI:1285796169
Name:BUNSICK, STANLEY CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:CHARLES
Last Name:BUNSICK
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:106 4 SEASONS SHOPPING CTR
Mailing Address - Street 2:SUITE108
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3173
Mailing Address - Country:US
Mailing Address - Phone:314-469-0964
Mailing Address - Fax:314-469-6080
Practice Address - Street 1:106 4 SEASONS SHOPPING CTR
Practice Address - Street 2:SUITE108
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3173
Practice Address - Country:US
Practice Address - Phone:314-469-0964
Practice Address - Fax:314-469-6080
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMO D124841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics