1699818872 NPI number — BUNCH-PAYNE, ORAL AND MAXILLOFACIAL SURGERY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699818872 NPI number — BUNCH-PAYNE, ORAL AND MAXILLOFACIAL SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUNCH-PAYNE, ORAL AND MAXILLOFACIAL SURGERY
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:
1699818872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
756 PORTER AVE
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95207-4232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-951-6387
Provider Business Mailing Address Fax Number:
209-951-2824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
756 PORTER AVE
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95207-4232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-951-6387
Provider Business Practice Location Address Fax Number:
209-951-2824
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUNCH
Authorized Official First Name:
FRED
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
209-951-6387

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: D46419 . This is a "DENTI-CAL DR PAYNE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: D21974 . This is a "DENTI-CAL DR BUNCH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DK858Z . This is a "PTAN - FRED BUNCH DDS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DK863Z . This is a "PTAN - JEFFREY PAYNE DDS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DK845A . This is a "PTAN - BUNCH-PAYNE OMS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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