Provider Demographics
NPI:1689233710
Name:BUNKERS, JACE (DDS)
Entity type:Individual
Prefix:
First Name:JACE
Middle Name:
Last Name:BUNKERS
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 1:1416 N SANBORN BLVD
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-1349
Mailing Address - Country:US
Mailing Address - Phone:605-996-2228
Mailing Address - Fax:605-996-8388
Practice Address - Street 1:1416 N SANBORN BLVD
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-1349
Practice Address - Country:US
Practice Address - Phone:605-996-2228
Practice Address - Fax:605-996-8388
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD12331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice