Provider Demographics
NPI:1366531121
Name:BUNCE, WILLIAM DAVID (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DAVID
Last Name:BUNCE
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 1:1774 COPE AVE E
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2662
Mailing Address - Country:US
Mailing Address - Phone:651-777-3620
Mailing Address - Fax:651-777-7899
Practice Address - Street 1:1774 COPE AVE E
Practice Address - Street 2:SUITE 110
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2662
Practice Address - Country:US
Practice Address - Phone:651-777-3620
Practice Address - Fax:651-777-7899
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN86661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice