1114769023 NPI number — UKANTI HEALTHCARE SERVICES PLLC

Table of content: DR. JENNIFER L. BUNDY DDS (NPI 1750556064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114769023 NPI number — UKANTI HEALTHCARE SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UKANTI HEALTHCARE SERVICES PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114769023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6960 RENO CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77708-3593
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2933 PARK PLAZA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ARTHUR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77642-5516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-234-9888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2024

Additional Information

Authorized Official

Authorized Official Last Name:
NWAOBI
Authorized Official First Name:
NKEM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
409-234-9888

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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