Provider Demographics
NPI:1396753919
Name:HANSEN-BUNCH, MARCIE ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARCIE
Middle Name:ANN
Last Name:HANSEN-BUNCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 W SHORE DR STE 300E
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4054
Mailing Address - Country:US
Mailing Address - Phone:972-235-3675
Mailing Address - Fax:972-235-3905
Practice Address - Street 1:1110 W SHORE DR STE 300E
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4054
Practice Address - Country:US
Practice Address - Phone:972-235-3675
Practice Address - Fax:972-235-3905
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165686003Medicaid
TX165686002Medicaid