Provider Demographics
NPI:1558149195
Name:BUBBLE GUM KIDS DENTISTRY CLINTON TWP
Entity type:Organization
Organization Name:BUBBLE GUM KIDS DENTISTRY CLINTON TWP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VP OF POSITION
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUNDLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-400-9999
Mailing Address - Street 1:41781 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1964
Mailing Address - Country:US
Mailing Address - Phone:203-400-9999
Mailing Address - Fax:
Practice Address - Street 1:41781 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1964
Practice Address - Country:US
Practice Address - Phone:203-400-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty